I asked Dr. John Kelso for his input. His response is as follows:
"The nature (maculopapular) and timing (1-1/2 hours after vaccine administration) of this patient's rash do not suggest an IgE mediated mechanism, although the timing suggests the vaccine was causal. There would not be any tests to prove this relationship nor to predict its recurrence. Assuming that the rash did not go on to involve other features suggestive of a severe cutaneous adverse reaction (SCAR), it would seem the benefits of repeat vaccination (protection from influenza disease) would outweigh the risks of a potential recurrence. The patient's egg allergy status is not a consideration for the receipt of egg-containing vaccines because they do not contain enough egg protein to cause reactions even in severely egg-allergic patients. The most recent guidance states that 'It is not necessary to inquire about egg allergy prior to the administration of any influenza vaccine, including on screening forms.' Thus, if the patient agrees with this risk-benefit analysis, I would recommend that she be vaccinated with a single dose of any other influenza vaccine than the one related to her reaction and be observed for 2 hours afterwards since this would include the timeframe of her original reaction. If no reaction occurred, in subsequent years, such observation would not be required."
Pre-treatment or graded doses would not be needed.
I hope this is helpful.
Daniel J. Jackson, MD, FAAAAI