Establishing the safety of influenza vaccine in egg-allergic individuals

CME EDUCATIONAL OBJECTIVES 1. Understand that trivalent influenza vaccine is safe for patients with egg allergy, including patients with severe egg allergy. 2. Understand that egg-allergic patients no longer require any special precautions to safely receive trivalent influenza vaccine. 3. Recognize that the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices advises that most egg-allergic patients can now receive trivalent influenza vaccine from their primary care physician. Trivalent influenza vaccine is grown in chick embryos and contains residual egg protein (ovalbumin). Historically, trivalent influenza vaccine (TIV) has been contraindicated in egg-allergic individuals (EAI) and the vaccine was withheld in many of these individuals due to the ovalbumin. However, protocols were developed that allowed EAIs to safely receive TIV, including stepwise desensitization, vaccine skin testing, and use of low ovalbumin containing vaccine. In the past 3 years, several groups have systematically disproven that EAI are at any increased risk for an allergic reaction than the general population and withholding TIV is not necessary. To date, approximately 4,315 patients have safely received 4,872 total doses of TIV, including 656 EAI with severe egg allergy (including anaphylaxis to egg) who safely received 740 doses of TIV. Thus, it is as safe to provide TIV to EAI as providing it to a non-EAI. This article will trace the evolution of this practice.