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Egg and flu vaccine

Question:

10/15/2020
This is an 8 month-old male who ate fried egg for the first time and immediately developed hives and facial swelling, necessitating a trip to the ER. Decadron and Benadryl were administered with resolution. Subsequent RAST component testing showed class IV to ovalbumin and ovomucoid and class III to egg yolk. All egg ingredients were omitted from his diet. Several weeks later mother switched from Nutramigen to Enfamil formula and infant ate multigrain crackers (oat) on the same day of the switch and developed hives again, was taken to the ER, and Benadryl and Decadron were administered again and an EpiPen was prescribed. Subsequent testing showed allergy to milk, oat and beef which were omitted from the diet. Patient has never had the flu vaccine because of his age. Can patient receive the flu vaccine this month? I know that the AAP say that patients can receive it unless they have had an anaphylactic episode which occurred at least once as per the above description. Secondarily, the mother is still breast feeding. Can she get the traditional flu vaccine as well? And should there be any lapse in breast feeding and if so, for how long?

Answer:

This (https://www.cdc.gov/flu/prevent/egg-allergies.htm) is the CDC recommendations for administering the flu vaccine in egg-allergic patients.

"Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive flu vaccine. Any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status may be used.

Persons who report having had reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status. The selected vaccine should be administered in an inpatient or outpatient medical setting (including, but not necessarily limited to hospitals, clinics, health departments, and physician offices). Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic conditions. "

I am of aware of any data that would suggest that mom should not receive the flu vaccine because she is breast feeding.

I hope this has been helpful.

Andrew Murphy, MD, FAAAAI