Update on influenza vaccination of egg allergic patients

摘要

The Adverse Reactions to Vaccines Practice Parameter 2012 update,1 consistent with new recommendations from the Centers for Disease Control's Advisory Committee on Immunization Practices (ACIP),2 recommended that egg-allergic persons receive injectable inactivated influenza vaccine (IIV) as a single dose without prior vaccine skin testing and be observed for 30 minutes afterwards for any possible allergic reaction. Furthermore, the update recommended that, if the reaction to the ingestion of eggs was hives only, the vaccine could be administered in a primary care setting, whereas if the reaction to the ingestion of eggs was more severe, the vaccine should be administered in an allergist's office.Since publication of the 2012 update:1. Examination of Vaccine Adverse Event Reporting System data after the new ACIP recommendations indicated no disproportionate reporting of allergy or anaphylaxis after influenza vaccination.2. Subsequent studies have been published on the administration of IIV to egg-allergic recipients, including those with severe reactions to the ingestion of egg.a. Des Roches et al4 describe their own study as well as the 26 previously published studies in which collectively 4,172 patients with egg allergy received 4,729 doses of IIV with no cases of anaphylaxis, including 513 with severe allergy who uneventfully received 597 doses.b. Greenhawt et al5 describe a multicenter, combined prospective randomized controlled trial and retrospective study, noting no vaccine-related reactions in an additional 143 patients with severe egg allergy.c. Both authors independently concluded that the risk of an adverse reaction to IIV is exceptionally low for any patient