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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

CDC boils down egg allergy flu shot exemption

As mandatory flu immunization policies continue to gain momentum in health care settings, egg allergy -- one of the classic exemptions to the vaccine -- is being redefined by public health officials.

As a result, fewer health care workers may receive exemptions from flu vaccine mandates, based on recent recommendations from the Advisory Committee on Immunization Practices (ACIP), which provides expert consultation to the Centers for Disease Control and Prevention.FN1

The panel listed trivalent inactivated vaccine (TIV) as a possible alternative for some people with mild reactions. Some package inserts for the trivalent inactivated vaccine no longer list hypersensitivity as a contraindication, although severe allergic reaction, such as anaphylaxis, remains a contraindication, says Lisa Grohskopf, MD, a medical officer with CDC’s influenza division.

“We are recommending in these guidelines that essentially only individuals who have hives – specifically, only hives -- as a symptom as their allergy, [can] go ahead and receive vaccine without some further risk stratification,” she says. “It's possible for a health-care worker to be stratified for the risk.”

People who experience only hives following exposure to eggs should be monitored for at least 30 minutes for signs of reaction. Other people with more severe reactions should be referred to a physician “with expertise in management of allergic reactions,” the guidelines state. The vaccine should be administered in a setting where there can be rapid recognition and treatment of anaphylaxis, CDC says. If someone has previously had a severe reaction to any component of the influenza vaccine, they should not receive the vaccine, the guidelines state.


1. Centers for Disease Control and Prevention. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011; 60(33);1128-1132