If you are allergic to eggs can you get a flu vaccination?

Answer 1

Update June 20, 2013:

The CDC has issued the following media advisory:

The Advisory Committee on Immunization Practices (ACIP) voted today, 13 to 0, in favor of recommending FluBlok during the 2013-2014 influenza seasons for vaccination of persons 18 through 49 years of age with egg allergy of any severity. FluBlok was licensed by the Food and Drug Administration (FDA) in January 2013. Unlike current production methods for other available seasonal influenza vaccines, FluBlok does not use the influenza virus or chicken eggs in its manufacturing process.

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Most of the vaccines in the flu vaccinations contain tiny/trace amounts of egg or chicken protein. An egg allergy is a contraindication (i.e., don't use) for these vaccines according to the manufacturers' original package information.

However, at least 17 recent studies determined that in some cases this does not need to prevent a flu vaccination with an inactivated vaccine (i.e., you can not use the nasal "live" vaccines) unless you have a severe egg allergy, and those are rare. You should check with your allergy specialist to find out if you are one who could get the flu shot even though you have the egg allergy. The allergist may want to administer the vaccine in the office so observation for signs of allergic response can be provided.

According to the US Centers for Disease Control and Prevention (CDC) new guidelines for administering flu vaccines to patients with Allergies to eggs have been published. The CDC has quite a bit of information about this topic on their web pages. The link to this information is provided below in the Related Links section. Here is an excerpt from that publication:

Recommendations Regarding Persons with Egg Allergy

Each of the following recommendations applies when considering influenza vaccination of persons who have or report a history of egg allergy.

1. Persons who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures: [see the link to the article below for more on those additional measures- Figure 2].

a) Because studies published to date involved use of TIV, TIV rather than LAIV should be used. [TIV = Trivalent Inactivated Vaccine (vaccines made with "dead" viruses), LAIV = Live Attenuated Influenza Vaccine (vaccines made with live but weakened viruses]

b) Vaccine should be administered by a health-care provider who is familiar with the potential manifestations of egg allergy.

c) Vaccine recipients should be observed for at least 30 minutes for signs of a reaction following administration of each vaccine dose.

Other measures, such as dividing and administering the vaccine by a two-step approach and skin testing with vaccine, are not necessary.

2. Persons who report having had reactions to egg involving angioedema, respiratory distress, lightheadedness, or recurrent emesis, or persons who required epinephrine or other emergency medical intervention, particularly those that occurred immediately or within minutes to hours after egg exposure are more likely to have a serious systemic or anaphylactic reaction upon reexposure to egg proteins. Before receipt of vaccine, such persons should be referred to a physician with expertise in the management of allergic conditions for further risk assessment (Figure 2-see full article).

3. All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available. ACIP recommends that all vaccination providers be familiar with the office emergency plan. [ACIP=Advisory Committee on Immunization Practices (CDC)]

4. Some persons who report allergy to egg might not be egg allergic. Those who are able to eat lightly cooked egg (e.g., scrambled eggs) without reaction are unlikely to be allergic. Conversely, egg-allergic persons might tolerate egg in baked products (e.g., bread or cake); tolerance to egg-containing foods does not exclude the possibility of egg allergy. Egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for immunoglobulin E antibodies to egg proteins.

5. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine.

There is no added sulfur in the flu vaccines approved for the 2011-2012 flu season in the US. But it is usually the protein from the egg itself that causes allergy to eggs, not the sulfur. And it is possible that some of the protein allergens might come from the eggs used in the process of growing the viruses for the vaccines, although there are only trace amounts. See the list of ingredients of the approved vaccines below.

The ingredients in these six US FDA approved 2011-2012 flu vaccines are:

Afluria from CSL Limited:

Beta-Propiolactone, Calcium Chloride, Neomycin, Ovalbumin, Polymyxin B, Potassium Chloride, Potassium Phosphate, Sodium Phosphate, Sodium Taurodeoxychoalate.

Fluvarix from GlaxoSmithKline (GSK) Biologicals:

Egg Albumin (Ovalbumin), Egg Protein, Formaldehyde or Formalin (to inactivate the virus), Gentamicin, Hydrocortisone, Octoxynol-10, á-Tocopheryl Hydrogen Succinate, Polysorbate 80 (an adjuvant), Sodium Deoxycholate, Sodium Phosphate, Thimerosal*

FluLaval from ID Biomedical Corporation:

Egg Albumin (Ovalbumin), Egg Protein, Formaldehyde or Formalin, Sodium Deoxycholate, Phosphate Buffers, Thimerosal

Fluvirin from Novartis Vaccines and Diagnostics Limited:

Beta-Propiolactone , Egg Protein, Neomycin, Polymyxin B, Polyoxyethylene 9-10 Nonyl Phenol (Triton N-101, Octoxynol 9), Thimerosal (in the multidose containers), Thimerosal* (much smaller amounts in the single-dose syringes)

Fluzone, Fluzone High-Dose, Fluzone Intradermalfrom Sanofi Pateur, Inc.:

Egg Protein, Formaldehyde or Formalin, Gelatin, Octoxinol-9 (Triton X-100), Thimerosal (only in multidose containers)

FluMist (nasal spray) from MedImmune Vaccines, Inc.:

Chick Kidney Cells, Egg Protein, Gentamicin Sulfate, Monosodium Glutamate,Sucrose Phosphate Glutamate Buffer

*Where "thimerosal" is marked with an asterisk (*) above, it indicates that the product should be considered equivalent to thimerosal-free products. This vaccine may contain trace amounts (<0.3 mcg) of mercury left after post-production thimerosal removal, but these amounts have no biological effect. JAMA 1999;282(18) and JAMA 2000;283(16)

See the related links below in the related links section for more information.

Answer 2

Eggs are used as the medium to create ("grow") the flu virus that is needed to make some of the vaccines. Although the manufacturing leaves only minute traces of egg/chicken protein behind, in some people with severe allergies to chicken or eggs, it was thought that it might be enough to trigger a severe and life-threatening allergic reaction. This is why, in the past, it was recommended that people with this type of allergy should not receive vaccines produced this way.

However, the most recent medical information is that in most cases, it is still safe to administer to those who have this type of allergy now with special precautions. With clinical monitoring after the vaccination for a short time period, this can be treated if there is the start of a reaction (often there is none due to the trace amounts). Tell the clinician who is going to give the vaccination that you have this type of allergy. See the related questions below for additional information.

Answer 3

Yes. As of June 20, 2013:

The CDC has issued the following media advisory:

The Advisory Committee on Immunization Practices (ACIP) voted today, 13 to 0, in favor of recommending FluBlokduring the 2013-2014 influenza seasons for vaccination of persons 18 through 49 years of age with egg allergy of any severity. FluBlok was licensed by the Food and Drug Administration (FDA) in January 2013. Unlike current production methods for other available seasonal influenza vaccines, FluBlok does not use the influenza virus or chicken eggs in its manufacturing process.