Cross-reactivity between the flu vaccine and the shingles vaccines
Question:
10/9/2024
I have 59-year-old female who had anaphylaxis to the flu vaccine in the past. She would like to get the shingle vaccine Zostivax. Is there any cross reactivity between the two? Is it safe to use Zostivax and if yes what precautions are necessary?
Answer:
A history of an anaphylactic or anaphylactoid reaction to gelatin, neomycin, or any other component of the live attenuated herpes zoster (shingles) virus vaccine are listed as contraindications in the package insert. Neomycin contact dermatitis is not a contraindication.
Each dose of live attenuated herpes zoster (shingles) virus vaccine contains 41.05 mg of sucrose, 20.53 mg of hydrolyzed porcine gelatin, 8.55 mg of urea, 5.25 mg of sodium chloride, 0.82 mg of monosodium L-glutamate, 0.75 mg of sodium phosphate dibasic, 0.13 mg of potassium phosphate monobasic, 0.13 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of neomycin and bovine calf serum. It contains no preservatives.
https://www.fda.gov/media/82524/download
Interestingly the current package insert for Fluzone High-Dose Quadrivalent (Influenza Vaccine) still lists severe allergic reaction to any component of the vaccine, including egg protein, or after previous dose of any influenza vaccine as contraindications. The vaccine is made from the virus-containing allantoic fluid of embryonated chicken eggs. Other components of the Fluzone High-Dose Quadrivalent (Influenza Vaccine) include sodium phosphate-buffered isotonic sodium chloride solution, formaldehyde and octylphenol ethoxylate. It contains no gelatin or preservatives.
https://www.fda.gov/media/132238/download
True anaphylaxis to flu vaccines is extremely rare and may be over-diagnosed. We also now know that individuals even with life-threating egg food allergy can safely tolerate flu vaccines made in embryonated chicken eggs.
McNeil MM, DeStefano F. Vaccine-associated hypersensitivity. J Allergy Clin Immunol. 2018 Feb;141(2):463-472.
In my experience most individuals with a history of flu vaccine anaphylaxis are skin test negative to the current years flu vaccine and tolerate vaccination.
Given the lack of any immunologically significant components shared by the two vaccines, there is no contraindication to vaccinating your patient for shingles. No special precautions need to be taken beyond what you would take for any individual receiving a vaccination.
Eric Macy, MD, MS, FAAAAI