Thank you for your inquiry.
I have never personally considered the use of intranasal vaccine in patients with large local reactions to injected influenza vaccine. The reason for this is that we have been able to successfully manage such patients by simply giving them reduced doses in more than one site. We have never had a patient react with a large local to a dose of 0.1 or 0.2 cc, and have therefore successfully managed such patients in this manner. However, conceivably, one could use intranasal vaccine in such patients.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.