Question of the Day
Wednesday, November 4, 2026
A 28-year-old female reports a history of anaphylaxis after eating scrambled eggs as a child, requiring epinephrine administration. She has avoided eggs since. She presents in October requesting an influenza vaccine. Which one of the following is the most appropriate recommendation?
Answer: B. She may receive any influenza vaccine without additional precautions
The correct answer is B (She may receive any influenza vaccine without additional precautions). Since the 2023-24 season, ACIP has recommended that people with egg allergy of any severity, including prior anaphylaxis to egg, receive any age-appropriate influenza vaccine, egg-based or egg-free, with no precautions beyond those used for every vaccine recipient. The ovalbumin content of current egg-based vaccines is too small to provoke a reaction, and large safety datasets show no excess anaphylaxis in egg-allergic recipients. Every vaccination site should still be ready to recognize and treat anaphylaxis, as it would be for any patient.
Why not A (She should not receive any influenza vaccine): Egg allergy is not a contraindication, and withholding vaccine leaves her unprotected. Only a prior severe allergic reaction to an influenza vaccine itself is a contraindication.
Why not C (She should receive only the recombinant influenza vaccine): Egg-free vaccines (recombinant or cell culture) are acceptable choices, but ACIP no longer requires them for egg allergy.
Why not D (She should undergo skin testing to egg protein prior to vaccination): Skin testing to egg or to the vaccine is not recommended before influenza vaccination.
Why not E (She may receive any influenza vaccine but should be observed in a medical setting equipped to manage allergic reactions): This was the pre-2023 advice for severe egg allergy; ACIP removed the special setting and supervision requirement.
Clinical Pearl: Egg allergy, even egg anaphylaxis, no longer changes which influenza vaccine a patient receives or where it is given.
Just show me the answer
Answer: B. She may receive any influenza vaccine without additional precautions
The correct answer is B (She may receive any influenza vaccine without additional precautions). Since the 2023-24 season, ACIP has recommended that people with egg allergy of any severity, including prior anaphylaxis to egg, receive any age-appropriate influenza vaccine, egg-based or egg-free, with no precautions beyond those used for every vaccine recipient. The ovalbumin content of current egg-based vaccines is too small to provoke a reaction, and large safety datasets show no excess anaphylaxis in egg-allergic recipients. Every vaccination site should still be ready to recognize and treat anaphylaxis, as it would be for any patient.
Why not A (She should not receive any influenza vaccine): Egg allergy is not a contraindication, and withholding vaccine leaves her unprotected. Only a prior severe allergic reaction to an influenza vaccine itself is a contraindication.
Why not C (She should receive only the recombinant influenza vaccine): Egg-free vaccines (recombinant or cell culture) are acceptable choices, but ACIP no longer requires them for egg allergy.
Why not D (She should undergo skin testing to egg protein prior to vaccination): Skin testing to egg or to the vaccine is not recommended before influenza vaccination.
Why not E (She may receive any influenza vaccine but should be observed in a medical setting equipped to manage allergic reactions): This was the pre-2023 advice for severe egg allergy; ACIP removed the special setting and supervision requirement.
Clinical Pearl: Egg allergy, even egg anaphylaxis, no longer changes which influenza vaccine a patient receives or where it is given.
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