Flu Vaccine and Egg Allergy: What You Need to Know!

Flu Vaccine and Egg Allergy:  What You Need to Know!

Do you still need to worry about egg allergies and the flu vaccine
An Update on the Flu Vaccine and Egg Allergies

The flu vaccine causes an annual wave of intern-level news reporting, poorly-written CDC campaigns, patient conspiracy theories and sarcastic doctor responses.  I joined this yearly event with my somewhat controversial approach to the flu shot last week.  It has become a predictable and mentally draining event.  But through all these reports, there is one patient type ignored when discussing the flu vaccine:  egg allergy patients.

If you or your child has an egg allergy, I’m here to help (now with 70% less sarcasm!)

I wrote today’s post to guide parents worried about flu vaccine for egg allergy kids.  But I will ask everyone TO SHARE this even if this doesn’t apply to you.  Why?

  1. The amount of misinformation surround flu vaccine for egg allergy this subject is huge!
  2. Some primary care doctors are 8+ years behind the current research so we need to help parents everywhere.
  3. This simple post can save flu vaccine/egg allergy parents upwards of $600!

 

Background on Flu Vaccine and Egg Allergy

Some prior flu vaccines were made was using an egg-based manufacturing process.  During this process, the influenza viral strains are into fertilized hen’s eggs and incubated to allow the virus to replicate.  The virus-containing fluid is then removed from the egg, purified, and sent for further production.

One side effect from this was that the flu shots contained egg protein which could trigger anaphylaxis in people with egg allergy (other side effects were that it took a long time to produce and required a large number of eggs).

If any of you remember getting the flu vaccine during that time you may remember questions asking about egg allergy.  And if either you or your child had an egg allergy, you also remember the long, complicated process of getting the vaccine:

  • To get a flu vaccine for mild egg allergy,  you had to wait 30 minutes in your provider’s office after the shot.
  • If you egg allergy was more severe, you had to see an allergist and go through an entire process of getting skin testing followed by a low dose injection followed by a high dose injection and an after-injection waiting period that often took half a day or longer!
  • Or your doctor told you NOT to get the vaccine and just hope for the best.

 

Luckily, we now live in the future!

 

Current Flu Vaccine Production Process

Currently, there are three CDC-approved flu vaccine production processes:

No egg allergen in modern flu vaccines
Modern techniques have solved the egg allergy problem!
  1. New Egg-Based Flu Vaccines — the newer processes have done an exceptional job at reducing the egg protein in flu vaccines to where egg is no longer an issue.  You CAN give current egg-based flu vaccine for egg allergy patients.
  2. Cell-Based Flu Vaccines — approved in 2012, this process creates the flu vaccine without using eggs at all.  These vaccines grow in mammalian cells instead of eggs reducing the concern for anaphylaxis.
  3. Recombinant Flu Vaccines — approved in 2013, the newest form of production also does not use eggs but grows the vaccine in insect cells.  This is the safest option for giving a flu vaccine and severe egg allergy because there is no risk of egg anaphylaxis (although you risk becoming The Fly… or getting superpowers, I guess.  50-50!)

 

What is important about this section is there have been significant advances over the years in influenza vaccine production to where egg protein is no longer a factor in getting the flu vaccine.

 

Are You Sure It’s Safe?

Yes.

The initial studies on the current egg-based vaccines began in 2008 by a friend of mine in the Army.  He  measured egg protein levels in flu vaccines made through the new production process and found the egg levels to be lower than they previously thought.  Since then, the process has continued to improve and there have been well-documented safety studies in egg allergic patients who paved the way to safely administer the flu vaccine for egg allergy.

These studies have are so conclusive that this year the CDC has officially stated there no additional wait time or consultation process needed for flu vaccines and egg allergy!

What Does This Mean to You?

This is great news –if you want the flu vaccine  (and I guess it’s bad news if you used egg allergy as a reason to avoid the flu shot.)  For you, this means:

  1. You can safely get you or your child with egg allergy a flu vaccine!
  2. You can do it fast!
    • You do not need to go to a doctor’s office to get the vaccine (you can get it at a supermarket, walgreens, costco, stranger off the street, etc)
    • You do not need to wait 30 minutes after vaccination
    • You do not need to see an allergist to get the vaccine
    • And you do NOT need to do a flu vaccine challenge protocol!

 

If you’re still worried (you may  a little skeptical and that’s OK), I have addressed this a little more below.

What If Your Egg Reaction Was Severe?

No problems with severe egg allergy and flu vaccine
Severe Egg Allergy? No problem!

I’ll answer the biggest question I get first.

If your/your child’s egg reaction was a severe, life-threatening “found near-dead on the floor” type of reaction… you can STILL get the flu vaccine and you can get it without no additional testing.

If you’re dealing with a have a severe egg allergy, there are two things I would recommend to ensure your safety:

  1. Ask for the recombinant flu vaccine, which is the safest for egg allergy (Flublock, which you can read about here)
  2. Get it in a professional medical setting (a doctor’s office or anywhere monitored by a nurse would be fine with me.  An allergist’s office is unnecessary.)

 

And that’s it!

Remember, this is only for severe, life-threatening egg allergy.  In the majority of situations, giving the flu vaccine for egg allergy patients does not require this level of care.

If you are worried or curious what level of care you might need, click here and answer 3 simple questions and I will suggest a safe location for your flu shot.

 

What If You Were Told Differently by your Doctor?

There are three scenarios where you might still be told that you need an egg challenge or an enhanced safety protocol:

Source 1: Friend or Family Advice

If you talk to a friend or family who has a child with an egg allergy (or they had an egg allergy themselves) they will often explain you need an egg challenge or at least a long wait at your provider’s office.

This is based on their past experience.  And it was true until a few years ago (the allergy literature suggested the change as early as 2010).  Tell them “thank you” for their advice.  But in this case, they are telling you old flu vaccine/egg allergy information.  This is not required any more with a flu vaccine for egg allergy patients.

Source 2: Your Primary Care Provider

Just this season alone, I have had three different primary care clinics ask me how they should proceed with the flu vaccine and egg allergy.   I thanked every one of them because they are doing the right thing:  putting their patient first and asking for the current recommendation  instead of assuming incorrect information.

The allergy community has known egg allergic patients don’t need an egg challenge for years.  But there is a delay in having this become standard practice in primary care offices.

My advice to primary care offices is the same:  “Thank you for asking and putting your patient’s safety first.  Luckily, there is no need for an allergist consultation or egg challenge for an egg allergic patient.”

Source 3:  Your Allergist

This one I take  personally.

There are still many allergists who are telling their patients they need to come in and do a full flu vaccine/egg allergy challenge protocol before getting their vaccine.

There’s only one reason for this – money.   An allergist who does a food challenge can charge upwards of $600 if they go through a full protocol.

The medical literature has been clear since for years that this is unnecessary and the official recommendation shows this is no longer necessary.  To be fair, I’ll concede that there might be a unique patient who would need this special circumstance.  But this should be at the frequency of one patient every few years. (For reference, I have not had an egg allergic patient who needed this level of treatment in the past 5 years).

This practice frustrates me because it cheapens what it means to be an allergist.  An allergist should be a patient’s advocate first and foremost.  Allergy is a confusing subject.  It already has so much misinformation, inappropriate practitioners and false/incomplete treatments we, as allergy professionals, need to be the one group that stands up for our patients and delivers perfect allergy care.  We need to be the one source that patients (and other medical providers) can turn to when they want allergy answers.

Unfortunately, not every allergist feels this way.  And I’ve met quite a few happy to take $600 from you for an unnecessary medical procedure.

If your allergist is recommending the flu vaccine and egg allergy protocol, I think you may question whether it is necessary.  If you are getting the run around and sketchy answers, email me — you can always rely on me for honest answers.

 

Summary

If you or your child has an egg allergy, you can now safely get the flu vaccine with no medication challenge, allergy consult or special accommodations.  Even if the egg allergy is a severe, life threatening one!

 

Questions?

If you have any questions, please send me a message and I’ll be happy to help.  This is an important topic and one that I want to make as easy as possible.

 

Sources:

1. Ovalbumin content in 2009 to 2010 seasonal and H1N1 monovalent influenza vaccines.  Waibel KH, Gomez R.  J Allergy Clin Immunol. 2010 Mar;125(3):749-51, 751.e1.
2. Recommendations for Prevention and Control of Influenza in Children, 2016-2017. COMMITTEE ON INFECTIOUS DISEASES. Pediatrics. 2016 Sep 6. [Epub ahead of print]
3. Use of Live Attenuated Influenza Vaccine in Children With Egg Allergy and Asthma.  Kelso JM. J Pediatric Infect Dis Soc. 2015 Mar;4(1):81-2.
4. Recommendations for Prevention and Control of Influenza in Children, 2015-2016.  Committee on Infectious Diseases, American Academy of Pediatrics. Pediatrics. 2015 Oct;136(4):792-808.
5. Live attenuated influenza vaccine for children with egg allergy.  Greenhawt M.  BMJ. 2015 Dec 9;351:h6656
6. Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study.  Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn-Lajeunesse M; SNIFFLE-2 Study Investigators. BMJ. 2015 Dec 8;351:h6291
7. Influenza vaccination: What’s new this season? Campos-Outcalt D. J Fam Pract. 2015 Sep;64(9):573-6.
8. Safety of influenza vaccination in children with allergic diseases.  Yang HJ. Clin Exp Vaccine Res. 2015 Jul;4(2):137-44

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