Advice from FAAN

The yearly flu vaccines are recommended for all children over age 6 months. These vaccines contain a very small amount of egg protein, and this raises concerns about giving them to children with egg allergy.

For many years, physicians and various medical societies and expert panels recommended avoidance of these vacines in children with severe egg allergy. This thinking has been changing.

Over the years, several vaccine manufacturers have begun to label the vaccines with the amount of egg that they contain, and it appears that some have much less egg protein than they had many years ago. Additionally, studies have emerged showing that the vast majority of children with egg allergy, even those with severe egg allergy, tolerate the vaccines.

The focus of avoiding these vaccines has primarily been aimed at children with severe egg allergy. This means that a child with mild egg allergy could get the vaccine. It is recognized, however, that there may be difficulty in deciding who has a mild compared to severe egg allergy.

Various professional organizations and individual allergists have suggested a variety of approaches to increase the safe use of these vaccines for children with egg allergy. The advice varies from selecting a vaccine labeled as being low in egg protein and injecting it in the usual manner without any prior testing, to performing allergy skin tests with the vaccine and using the results for deciding upon administering the vaccine. In some cases, the physician will divide the vaccine dose into a number of smaller injections.

All of the experts recommend that the vaccine be given under supervision of a physician who is prepared to treat any allergic reactions. The good news is that studies thus far show that reactions are very uncommon, and if they occur are usually quite mild, such as mild swelling at the site of injection.

While the seasonal and H1N1 influenza vaccines are recommended for all children, they are particularly important for children with asthma who are susceptible to more serious illness due to the flu. Many children with egg allergy also have asthma, making vaccination particularly important for them.

Professional organizations are recognizing that the low risk of vaccination reactions is overshadowed by the great benefits of vaccination and they are presenting options to follow for giving these vaccines to everyone with egg allergy. As new studies emerge, and as manufacturers label and test their products for egg content, it is likely that guidelines for administering these vaccines will be more and more liberal in encouraging vaccination with less concern, less testing, and in single doses without using multiple smaller shots that are uncomfortable.

Talk to your pediatrician and allergist and strongly consider these important vaccines for your child with egg allergy.

More inforamtion on egg and other allergies from FAAN, the Food Allergy and Anaphylaxis Network.

First published in July 2010

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