February 16, 2015 | Black & Kletz Allergy
With the recent resurgence of vaccine-preventable diseases like measles in the United States, in addition to the ongoing active influenza (flu) season, the issue of food allergies and vaccinations has become a hot topic.
Some vaccines like the MMR (measles, mumps, and rubella), influenza, yellow fever, and certain rabies vaccines are grown in chicken embryo cultures and may contain small amounts of egg protein in them, raising concerns about potential adverse reactions in children and adults with egg allergies.
Other vaccines contain small amounts of gelatin which can cause adverse reactions in patients allergic to gelatin. Some of these vaccines include MMR, influenza, varicella, DTaP (diphtheria, tetanus, and acellular pertussis), yellow fever, rabies, shingles (herpes zoster), and Japanese encephalitis.
Below are the most current recommendations as of February 2015:
- MMR vaccine:
- Can be safely given in a single dose without prior testing in all children and adults with a history of egg allergy.
- Influenza vaccine:
- People with a history of egg allergy who have experienced hives (urticaria) after exposure to should not receive the live influenza vaccine (FluMist). They can, however, receive a recombinant (egg-free) influenza vaccine (Flublok) if they are 18 years of age or older, or they can receive an inactivated vaccine. Either the recombinant or the inactivated influenza vaccine must be administered by a health care provider familiar with the potential manifestations of egg allergy. The patient must also be observed by the provider for at least 30 minutes for signs of a reaction after administration of each vaccine dose. Note that neither the recombinant (Flublok) nor the inactivated influenza vaccines contain any live influenza virus, unlike the live attenuated (weakened) influenza vaccine (FluMist) which does contain live influenza virus. FluMist is given intranasally (in the nose) rather than the inactivated influenza vaccine which can be given either as an intramuscular or an intradermal injection. The recombinant influenza vaccine is given as an intramuscular injection. Also note that FluMist is only given to individuals from ages 2 through 49. FluMist should not be given to pregnant women or in patients with an immunodeficiency (weakened immune system) without consulting their physician. FluMist should not be given to children and adolescents through age 17 years of age who are receiving aspirin therapy or aspirin-containing therapy because of the association of Reye’s Syndrome with aspirin and wild-type influenza infection.
- People who have had more severe reactions to egg such as dizziness and/or lightheadedness, angioedema (swelling), vomiting, breathing difficulties (i.e., wheezing, shortness of breath), and/or who have been treated with epinephrine in the past for an egg allergy can also receive the recombinant influenza vaccine (egg-free) if they are 18 years of age or older or an inactivated influenza vaccine. This must only be given by a physician, such as an allergist, with experience in the recognition and management of severe allergic conditions like anaphylaxis. These individuals must also be observed for at least 30 minutes after vaccination.
- People who have had anaphylactic reactions to the previous doses of any vaccine due to sensitivity to any of its components (i.e., gelatin, thimerosal, antibiotics) of the vaccine, should not receive any further doses of that particular vaccine. Note that thimerosal-free influenza vaccines can be obtained for those who are either allergic to thimerosal or do not want thimerosal.
- Individuals who have had Guillan-Barré Syndrome (a severe paralyzing illness) should not get any vaccine without consulting their physician.
- People with egg allergies should also not get the vaccinations for yellow fever and certain rabies vaccines since they also may contain small amounts of egg protein. The rabies vaccine Imovax can however be given to people with egg allergies, as Imovax is not cultured in chicken embryos and therefore does not contain egg proteins. Desensitization to the yellow fever vaccine can be performed by an allergist in a medical setting. If either the yellow fever or rabies vaccine is necessary, please consult with your physician.
The board certified allergists of Black & Kletz Allergy have over 50 years of experience in addressing the vaccination needs of people with food allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area based on the latest evidence-based clinical guidelines. If you need to consult us on vaccinations, please make a appointment at one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA.
Dr. Michael R. Kletz has done clinical research on the topic of the administration of egg-derived vaccines in patients with a history of egg sensitivity. Please click his research article that was published in the Annals of Allergy in the following link: http://www.ncbi.nlm.nih.gov/pubmed/2346238
