By Richard Rupp and Bridget Hawkins
 
Dear VaccineSmarts,
 
My son has not had any vaccines since he was 6 months old because he developed an allergy to eggs. His doctor said he shouldn’t be vaccinated because of the allergy. Now he needs his vaccines to start preschool, and his new doctor says my son should have been vaccinated. Which doctor is right? 

Kalli,
Dickinson

Dear Kalli,

Your son’s first doctor was being overly cautious, but that is understandable, given that there has been a lot of concern over this issue in the past.

Fortunately, the U.S. Centers for Disease Control and Prevention has clear recommendations on the subject.
 
Most routine childhood vaccines are not made using eggs and so your son should have been vaccinated.
 
The vaccines that protect against the flu and for measles, mumps and rubella are made by processes utilizing chicken eggs.

People with allergies to chickens or feathers have not been shown to be at increased risk for reaction to these vaccines.

Skin testing for an allergy to the MMR vaccine for measles, mumps and rubella was recommended in the past. Several studies in children with severe egg allergies have shown that this is unnecessary.

The modern MMR vaccine does not contain enough egg protein to cause allergic reactions. Neither the CDC nor the American Academy of Pediatrics consider egg allergy as a reason to not get the MMR vaccine.

The CDC recommends routine vaccination of egg-allergic children without the use of any special procedures.
The flu vaccine is another matter. Great caution needs to be exercised when vaccinating someone with a life-threatening egg allergy. Life-threatening means that eggs cause difficulty breathing, swelling of the mouth or lips or cardiovascular problems such as low blood pressure.

These children should only be vaccinated by a physician with expertise in the management of allergic conditions. Adults with egg allergy should receive the new recombinant flu vaccine FluBlok because it is completely egg free. Egg-free vaccines should become available for children in the near future.

The CDC recommends that children who can eat lightly-cooked eggs, such as scrambled eggs, without a problem should receive the injected flu vaccine without following any special procedures.

Note that we say “lightly cooked.” Being able to tolerate eggs in baked items such as cakes does not mean that a person does not have a significant egg allergy.

Children whose reaction to eating eggs is to only develop hives, can receive the injectable flu vaccine. The vaccine should be given in a setting ready to administer emergency care on the off chance that it is needed. The child should be observed in that setting for a minimum of 30 minutes.

There isn’t much known about the use of the nasal flu vaccine in egg-allergic individuals. At this time, it is not recommended for children.

The vaccines required for school, including the MMR, are not an issue. It sounds as if your son is missing a lot of vaccines. He will need to be on a catch-up vaccination schedule so he can be protected before starting school.

You should discuss with your son’s doctor whether your son should see an allergy specialist before receiving the flu vaccine.

Dr. Richard Rupp is a pediatrician and member of UTMB’s Sealy Center for Vaccine Development. Bridget Hawkins, Ph.D., is the assistant director of the Sealy Center for Vaccine Development. This column is supported by a UTMB President’s Cabinet Award to provide information about vaccines. Visit www.utmb.edu/scvd/vaccinesmarts for more information.