Egg-allergic children can receive influenza vaccine

Clinical question Can children with egg allergy receive influenza vaccine?

Bottom line Children with egg allergy can be treated with 10% of the normal vaccine dose followed in 30 minutes with the remaining 90% of the dose if they show no reaction. In this study, children were observed for 30 minutes after the second dose before release. Also, the study was performed in an office where treatment for anaphylaxis was available; administration of influenza vaccine to egg-allergic children should not occur at a local store. (Level of evidence = 2b)

Synopsis These investigators studied the results of 171 children with egg allergy who went on to receive influenza vaccine. One cohort of 56 patients was selected after skin prick testing for egg allergy; 53 patients who tested negative and three who tested positive received the vaccine. Of these, 95% (95% CI, 85.1%-98.9%) tolerated the vaccine without serious adverse reaction. Based on these results, the investigators evaluated a second cohort of 115 children who were not skin tested. They received one-tenth of the normal dose followed in 30 minutes with the rest of the dose if they did not experience a reaction. In these children, 97% (91.3%-99.0%) tolerated the vaccine without serious reaction. Systemic reactions, when they occurred, included wheezing, hives, eczema exacerbation, and facial flushing. These were all single doses and we do not know whether this two-shot approach to dosing must be performed with subsequent vaccinations.

Chung EY, Huang L, Schneider L. Safety of influenza vaccine administration in egg-allergic patients. Pediatrics. 2010;125(5): e1024-e1030.