Intended for healthcare professionals

Clinical Review

Recommendations for the administration of influenza vaccine in children allergic to egg

BMJ 2009; 339 doi: (Published 15 September 2009) Cite this as: BMJ 2009;339:b3680
  1. M Erlewyn-Lajeunesse, consultant in paediatric allergy 1,
  2. N Brathwaite, consultant in paediatric allergy2,
  3. J S A Lucas, honorary consultant in allergy and respiratory paediatrics1, senior lecturer in child health3,
  4. J O Warner, professor of child health4
  1. 1Southampton University Hospitals NHS Trust, Southampton
  2. 2King’s College Hospital, London
  3. 3Infection Inflammation and Immunology, School of Medicine, University of Southampton, Southampton
  4. 4Imperial College and Imperial College Healthcare NHS Trust, London
  1. Correspondence to: M Lajeunesse, The Children’s Allergy Clinic, Southampton University Hospitals NHS Trust, Southampton SO16 6YD mich.lajeunesse{at}
  • Accepted 6 September 2009

Summary points

  • Egg-free, mammalian culture based flu vaccines should be given preferentially to individuals allergic to egg

  • If an egg-free vaccine is not available, only vaccines with a stated maximum egg content <1.2 μg/ml (0.6 μg per dose) should be used in individuals allergic to egg

  • If egg based vaccine is administered to individuals with egg allergy, this should be done in a centre experienced in the management of anaphylaxis

  • A single dose protocol is recommended for those with less severe egg allergy

  • A two dose, split protocol can be used in those with anaphylaxis to egg or those with moderate or uncontrolled asthma

Egg allergy affects about 2.6% of preschool children by 3 years of age, and influenza immunisation using egg based vaccines has been classified as a “relative contraindication” (prescribe with extra caution) in this patient group.1 Until now the numbers of children with egg allergy requiring immunisation has been low, but this may change with the potential for a mass immunisation campaign. This article reviews the literature on the safety of flu vaccines and provides guidelines for the administration of these vaccines to children with egg allergy. Although egg-free flu vaccines are expected to be available for this season, the provision of sufficient amounts of this vaccine cannot be guaranteed at the time of writing, and a pragmatic strategy for the safe immunisation of children with egg allergy is required.

Sources and selection criteria

We identified articles using PubMed and the search terms “influenza” and “egg allergy”. We identified further references within relevant papers. We found two randomised clinical trials, but most evidence comes from small case series.

What vaccines are available?

This season two varieties of flu vaccine will be available: a pandemic A/H1N1 strain and the normal trivalent seasonal flu vaccine that will contain an A/H1N1 virus but will not protect against the pandemic …

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