1. Influenza vaccine safety in persons with egg allergy
Vaccine Preventable Disease Programme
Public Health Wales
Flu season
Vaccine Preventable Disease Programme: Promoting immunisation in Wales

2. Egg products in influenza vaccines
All currently available influenza vaccines are manufactured using hens’ eggs
Purification during production aims to remove egg products from the finished vaccine, leaving less than one millionth of a gram of ovalbumin protein per dose
Flu vaccines containing less than 0.06 microgrammes ovalbumin per dose are designated very low ovalbumin vaccines

3. JCVI recommendations
JCVI advise almost all individuals with egg allergy can safely receive influenza vaccine containing very low levels of ovalbumin (<0.06 μg/dose) in general practice
Those with a history of severe anaphylaxis to egg requiring admission to intensive care are recommended egg-free vaccine or referral for immunisation in hospital
No egg-free vaccine is currently available
Immunisation against infectious disease (the Green Book) 2016
JCVI minutes February 2015

4. JCVI recommendations
JCVI advise as a precaution that those with a history of severe anaphylaxis to egg that previously required admission to intensive care should be immunised in hospital with a very low ovalbumin vaccine (<0.06μg/dose)
This is a very small group of patients
JCVI’s view is that the benefits of vaccination generally outweighs the risk in this patient group, based on evidence of safety in large series of patients
Immunisation against infectious disease (the Green Book) 2016

5. Safety data
A large number of studies including thousands of individuals show flu vaccines containing very low levels of ovalbumin may be used safely in individuals with egg allergy (Des Roches et al, 2012)
Des Roches A, Paradis L, Gagnon R, et al. (2012). Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol. 130(5):1213-6

6. Des Roches et al study
Studied flu vaccination in 367 patients with egg allergy, including 132 with severe allergic reaction defined as the occurrence of anaphylaxis or cardiorespiratory symptoms on egg ingestion
None of these 132 patients who received an egg based flu vaccine developed anaphylaxis
Des Roches A, Paradis L, Gagnon R, et al. (2012). Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol. 130(5):1213-6

7. Other studies Des Roches identified a further 26 studies
With their own data the series included 4172 patients, 513 of whom had a history of severe reactions
All received egg grown flu vaccine
None developed anaphylaxis
Des Roches A, Paradis L, Gagnon R, et al. (2012). Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol. 130(5):1213-6

8. Estimated risk of anaphylaxis
The risk based on the 513 patients with severe egg allergy (none of whom had anaphylaxis after flu vaccination) was calculated
The risk of anaphylaxis was 0% % (95% CI)
Equivalent to 0 to 1 in 161 doses
Des Roches A, Paradis L, Gagnon R, et al. (2012). Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol. 130(5):1213-6

9. Guidance document:
flu vaccine brands with a low ovalbumin content:<0.06 μg for a 0.5 ml dose (equivalent to
<0.12 μg /ml) are listed here:
This management chart for flu vaccination in egg allergic patients for season can be viewed here:
The management chart outlined above also includes the full list of flu vaccines available this season as well as their ovalbumin content.

10. More at http://howis.wales.nhs.uk/immunisation

11. Acknowledgements PHW–VPDP intranet site Public Health England
Public Health England
VPDP team members
Other references included in slides
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Acknowledgement to Public Health Wales NHS Trust to be stated.
© 2018 Public Health Wales NHS Trust.