Influenza Vaccine Recommendations: Allergies

INFLUENZA VACCINE RECOMMENDATIONS: ALLERGIES

All vaccination providers should be familiar with the office emergency plan and have current certification in cardiopulmonary resuscitation. Epinephrine and emergency equipment for airway maintenance must be readily available for immediate use.

                   
  Did the person have a previous severe allergic reaction to influenza vaccine?  
 
Yes
 
Future receipt of influenza vaccine is contraindicated or precautioned
(see table below)
   
       
     
No
 
       
   
  After eating eggs or egg-containing foods, does the person experience ONLY hives?  
 
Yes
 
Administer IIV4, RIV4, or LAIV4 (any formulation appropriate for recipient’s age and health status)    
 
 
 
     
No
 
 
     
 

After eating eggs or egg-containing foods, does the person experience other symptoms such as:

• Angioedema

• Respiratory distress

• Lightheadedness

• Recurrent emesis

• Reaction requiring epinephrine

• Reaction requiring emergency medical attention

 

Yes

 

Administer IIV4, RIV4, or LAIV4 (any formulation appropriate for recipient’s age and health status)


Vaccine other than ccIIV4 or RIV4 should be administered in an inpatient or outpatient medical setting (eg, hospitals, clinics, health departments, physician offices), under the supervision of a healthcare provider who is able to recognize and manage severe allergic reactions.

 
 
 
 
 
                 
VACCINE CONTRAINDICATIONS AND PRECAUTIONS
Influenza Vaccines (2021-22 season)
Vaccine associated with previous severe allergic reaction
Egg-based IIV4s and LAIV4
ccIIV4
RIV4
Any egg-based IIV or LAIV Contraindication Precaution* Precaution*
Any ccIIV Contraindication Contraindication Precaution*
Any RIV Contraindication Precaution* Contraindication
Unknown influenza vaccine Consult with allergist
NOTES

Key: ccIIV4 = Cell Culture-based Inactivated Influenza Vaccine, Quadrivalent; IIV4 = Inactivated Influenza Vaccine, Quadrivalent; LAIV4 = Live Attenuated Influenza Vaccine, Quadrivalent; RIV4 = Recombinant Influenza Vaccine, Quadrivalent

* Vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Providers can consider vaccination but should occur in an inpatient or outpatient medical setting under the supervision of a health care provider who is able to recognize and manage severe allergic reactions. Providers can also consider consulting with an allergist to help determine which vaccine component is responsible for the allergic reaction.

† Vaccine of any valency (eg, trivalent, quadrivalent)

REFERENCES

Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season. MMWR Recomm Rep. 2021;70(No. RR-5):1–28. DOI: http://dx.doi.org/10.15585/mmwr.rr7005a1.

(Rev. 9/2021)