What Does the Onset of Flu Season Have to do with an Egg Allergy?

For a few years, it seemed that every time we saw the allergist, our daughter’s food allergies increased. She had lived with a peanut allergy for 2 years and tree nut allergies for 1 year when she was diagnosed with an egg allergy. While we were still digesting this news, a friend asked, “Wow – what are going to do about the flu shot?”

Huh?

Yes, the influenza vaccine is incubated on egg embryos, so it can contain egg protein.  Alright, so since my daughter is allergic to eggs, she can’t get the flu vaccine anymore, right? Fine, I’ll just add it to my ever-growing list of things to avoid.

Now, you and I both know that, like most things in life, it’s not that simple. If you think the flu shot is an important part of staying healthy, then the diagnosis of an egg allergy complicates your life in multiple ways.

Based on my experience, the flu shot is not important at all – unless you’ve had the flu.

When I was growing up and later as a young adult, I never got the flu vaccine. It just wasn’t something my parents did. My husband, however, is a big proponent of the flu shot. Ever since I’ve know him, he has gone faithfully every year for his shot. And, I tell you, that man never gets sick.

When our girls were born, he insisted that they get the flu shot as soon as it was acceptable to the pediatrician. The Centers for Disease Control agreed with him, so our girls also got their annual flu shot, but I still never did.

Then one January, shortly after our youngest daughter turned 1, I got the flu for the first time ever. I coughed so hard that I broke a rib and had a fever for 10 days. In fact, one day I was so delirious with fever that I nearly fell asleep in the car with the engine running and the garage door down. (In hindsight, I shouldn’t have tried to run errands that day.) Needless to say, I’ve been a believer in the benefits of the annual flu shot since then.

So I was torn about what to do when our youngest daughter was diagnosed with an egg allergy just before the beginning of the flu season a few years ago. Let’s see: do I risk an anaphylactic reaction by giving my egg allergic pre-schooler the flu shot – which at the time was going to take 4-6 hours to administer, or do I skip the 6-hour shot and risk exposure to the flu virus, knowing first-hand the suffering it can cause?

Because she wasn’t attending school daily, we opted to skip the shot and risk her catching the flu.

But, now, our food allergic daughter is nearly 8, and we have taught her that she doesn’t have to live in isolation just because she has allergies. So, she goes to a wonderful (but huge: 1,000+ students) elementary school, takes dance classes 3 days a week, voice class 1 day a week and moves from one musical theatre production to another year round. With all those hours spent around so many other children, it was time to reconsider the flu shot.

I am thrilled to report that 1 week ago, our egg-allergic daughter got the flu shot and had NO negative reaction! If you’re considering the same for your egg-allergic child, please discuss it their allergist, do your research and proceed with caution.

Detail about the appointment:

  • 6 days before the appointment, she stopped taking all anti-histamines. Her system needed to be free of antihistamines for 5 full days so the skin prick testing would be accurate.
  • The nurse took her height, weight and temperature.
  • We discussed epinephrine and the different providers. At 50 pounds, the child switches from the “Jr” dose of epinephrine to the full dose, which is a great fact to make note of.
  • We discussed the skin pricks we’d be doing. Since our child had a full array of food allergen testing conducted just before the start of the school year, the allergist indicated that we did not to test her again for egg. So, rather than setting up 4 skin test, including egg protein, she set up 3:

  1. Positive control: histamine
  2. Negative control: saline
  3. The test item: influenza vaccine (ie: flu shot)

A bit of detail about the skin pricks:  It was set up just like the skin pricks for food allergens using the plastic tool that looks like a caterpillar.  For this test, there were only 3 “legs” each containing one of the 3 items above.  Everyone should react to the histamine (unless they have been taking antihistamines), and no one should react to the saline.  Her back was pricked with the 3-legged caterpillar.  After 15 minutes the flu shot skin prick was compared to the 2 controls to determine if there might be a reaction to the flu shot.

  • If the flu shot skin prick was red, raised, had increased in size, was itchy or otherwise resembled the histamine prick, that was read as a positive reaction to the flu vaccine. It could still be administered, but 1/3rd at a time.
  • If the flu shot skin prick looked like the saline prick (ie: not very irritated at all), that was read as no reaction to the flu vaccine. The flu shot would be administered ½ at a time.
  • Fortunately, our daughter’s flu shot skin prick showed no reaction, and she could receive the flu shot in 2 doses: ½ at a time.
  • Then she got ½ the dose in the upper arm, and we waited 15 minutes. Then her injection site was checked, and there was no apparent reaction there as well.
  • The second ½ of the shot was injected into the other arm, and we waited another 15 minutes. Again, no reaction at the site. The injections went without incident and we were free to leave!

Of course, we didn’t end up leaving for about another 30 minutes, because we asked the doctor some questions (see below). I have to admit that this gave me further peace of mind; if she was going to have a reaction, it probably would have happened pretty fast. Being in the doctor’s presence for a little longer made me feel more comfortable.

Doctor Q&A:

  • Since she didn’t have a reaction, can we just go to the pediatrician next year and get the shot there in 1 dose? Probably not advisable: the flu vaccine is different every year, so her sensitivity could be different. Best to do it under the allergist’s watch in smaller doses.
  • Does she need a booster this year? Yes. Since it’s been several years since she’s had the flu vaccine, they treat her as if she’s never had it. So she’ll need another dose in about 1 month.
  • Do we have to do the skin prick tests again for the booster? No – but only because the doctor set aside the exact vial that she drew today’s dose from and saved it for our child. We proved that our child won’t have a reaction to that vial of the vaccine, but there’s a risk of reaction if the booster dose comes from a different vial.
  • If she would have had a reaction to the vaccine, what might it have been? It could have been as localized as a raised, itchy bump at the injection site or a broader reaction such as hives. In reality, it could have been any of the symptoms of an allergic reaction that we all are intensely aware of, which is why the shot is given gradually and the child is watched closely. The doctor can step in quickly and give epinephrine if the reaction begins to intensify.

We were at the doctor’s office for about 2 hours total, and the process went as smoothly as possible. If you’d like to consider the flu shot for your egg-allergic child, please discuss it with their allergist and weigh the risks before you move ahead.

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About Amy

Amy Jones Anichini is the Founder of Egg-Free Epicurean (formerly an allergy-safe bakery) and a consultant to start-up food businesses. She is also a wife, mother of two, food allergy advocate, and author. Ms. Anichini holds an MBA in Finance from the Chicago Booth School of Business, and a BS in Finance from the University of North Carolina at Chapel Hill, and holds the CFA charter.
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