Patients Aged 6 Months and Older with Egg Allergy Should Receive Flu Vaccine
October 15, 2025
By John Di Cristofano, PharmD
Synopsis: The Advisory Committee on Immunization Practices (ACIP) provided updated guidance for the 2025-2026 influenza season. After reviewing data on egg-based influenza vaccines, ACIP reinforced that individuals with egg allergies are not at increased risk of severe allergic reactions and outlined precaution and contraindication considerations in vaccine administration for this population.
Source: Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2025-26 influenza season. Published Sept. 2, 2025. https://www.cdc.gov/flu/media/pdfs/2025-2026-summary-of-recommendations.pdf
After reviewing egg-based influenza vaccines (including inactivated seasonal, monovalent H1N1, and live attenuated formulations) in people with a history of egg allergy, updated Advisory Committee on Immunization Practices (ACIP) recommendations reconfirm that these individuals are not at higher risk of severe allergic reactions to egg-based flu vaccines.1 With these data, the 2025-2026 updated ACIP guidance reaffirms that patients aged 6 months and older with an egg allergy should receive the influenza vaccine.2
Furthermore, they suggest that any influenza vaccine that is appropriate for the recipient’s age and current health status may be considered for use. The guidance here also recommends that patients with egg allergies are not at an increased risk of severe allergic reactions to egg-based influenza vaccinations and that having an egg allergy no longer requires the administering clinic to provide any additional safety measures other than those that already are recommended for the receipt of any vaccine. Available types of vaccines currently on the market include inactivated influenza vaccines (IIV3s), such as Afluria, Fluarix, Flucelvax, FluLaval, and Fluzone (and Fluzone High-Dose); recombinant influenza vaccines (RIV3), such as Fluad; and live attenuated influenza vaccines (LAIV3), such as FluMist. The majority of these are manufactured using egg-based technology (produced in embryonated chicken eggs) and contain small amounts of egg proteins.2 Of these, the following vaccines are egg-based influenza vaccinations available during the 2025-2026 influenza season: Afluria, Fluarix, FluLaval, Fluzone (and Fluzone High-Dose), Fluad, and FluMist.2
Data supporting this reaffirmed egg-allergy guidance for the 2025-2026 influenza season come from a systematic literature review that assessed the published evidence available through Oct. 26, 2021.1 Types of studies included observational studies; randomized, controlled trials; case series; case reports; and safety surveillance system reports. Only the data with known vaccine types and dosing protocols were included. The evidence was stratified by the severity of egg allergy (all severities vs. a history of severe allergy/anaphylaxis) and vaccine type. A Grading of Recommendations, Assessment, Development, and Evaluation assessment was completed on key outcomes, which included death, anaphylaxis, hospitalization for allergic reaction, outpatient/emergency department (ED) allergic reactions, and allergic manifestations following vaccinations.
For seasonal inactivated influenza vaccines, among the 1,591 egg-allergic individuals included across all studies, there were no events of death, anaphylaxis, or hospitalization for allergic reactions.1 Similarly, the same results held true for the 5,235 egg-allergic individuals receiving the monovalent H1N1 inactivated vaccines and 1,129 egg-allergic individuals receiving live attenuated influenza vaccines. There was a small percentage of individuals who experienced mild to moderate allergic reactions (requiring outpatient/ED attention or medication), which was not found to be clinically significant. Among the participants who have had a prior severe egg allergy or history of anaphylaxis, zero events of death, anaphylaxis, or hospitalization occurred after vaccine administration (0/322 of participants in the seasonal inactivated vaccine group; 0/66 of participants in the monovalent H1N1 inactivated group; and 0/412 of participants in the live attenuated vaccine group).1
Overall, across all vaccine types included in the data, there was a low frequency of adverse events, and no predefined critical outcomes occurred. However, some important limitations to note include that all studies included in this systematic review were observational and all, except for one randomized study, did not include comparison groups. There also were some studies that conducted skin testing with egg proteins or vaccine prior to making the decision to include the participant for vaccination, which could be seen as a form of selection bias. One other note here is that the observation time after vaccination varied with each study. However, the typical time was less than four hours for most studies.
Commentary
Across the literature referenced, no severe allergic reactions (anaphylaxis, hospitalization, and death) were found following egg-based vaccination administered to egg-allergic individuals.1 There was a small incidence of non-severe allergic events (reactions requiring symptomatic treatment) with an incidence rate of less than 1%. This held true for those individuals who had a history of severe egg allergy or history of anaphylaxis. Following this systematic review, ACIP held prior recommendations for the 2025-2026 influenza season in that those individuals aged 6 months and older with an egg allergy, regardless of prior allergic reaction severity, should receive annual influenza vaccination, even if the vaccine is an egg-based formulation.2 It is important to note here, for those recipients who have had a prior severe allergic reaction to a specific influenza vaccine formulation, additional administration of that same vaccine formulation is contraindicated.
Although consistent with prior updates, this updated guidance reemphasizes the importance of eliminating unnecessary barriers to vaccination by specifically addressing that patients with an egg allergy should be vaccinated without unnecessary delay or any added precautions beyond those of standard vaccine administration protocols. Although most vaccines remain manufactured using egg-based technology and contain trace amounts of ovalbumin, these formulations have not been shown to increase the risk of clinically significant reactions. Therefore, influenza vaccination in egg-allergic patients is considered safe by ACIP and should not present as an obstacle to influenza vaccination.2 This reaffirmation by ACIP will be helpful toward preventing further delays with vaccination avoidance because of egg allergy concerns while also contributing to broader vaccine acceptance among those who remain hesitant.
John Di Cristofano, PharmD, is a Clinical Pharmacist, HCSC, Chicago.
References
- Centers for Disease Control and Prevention. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE): Safety of influenza vaccines for persons with egg allergy. Reviewed Aug. 20, 2024. https://www.cdc.gov/acip/grade/influenza-egg-allergy.html
- Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2025-26 influenza season. MMWR Morb Mortal Wkly Rep. 2025;74(32):500-507.
The Advisory Committee on Immunization Practices (ACIP) provided updated guidance for the 2025-2026 influenza season. After reviewing data on egg-based influenza vaccines, ACIP reinforced that individuals with egg allergies are not at increased risk of severe allergic reactions and outlined precaution and contraindication considerations in vaccine administration for this population.
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