Egg Allergy, Asthma, and a Flu Shot, But Which One?

It is early October and you are seeing a child in your office for his 5-year check up. While he is there, you write refills for an albuterol inhaler (he has mild intermittent asthma) and for an injectable epinephrine kit. At the age of 3 years he broke out in hives on his face and extremities after eating some scrambled eggs. He was subsequently seen by an allergist who confirmed the egg allergy with blood IgE testing.

Mom has read somewhere that children with asthma are at higher risk for complication from influenza and she requests that you vaccinate him today if it can be done safely.  He has never received a dose of flu vaccine before.

You tell mom that:

A. A new flu vaccine called FluBlok is egg-free and he should receive that.

B. It is acceptable to give him the flu shot, but he will need to be watched in the office for at least 30 minutes after being vaccinated.

C. If he didn't have a history of wheezing, you could give him the live attenuated flu vaccine (FluMist) since the amount of egg in that vaccine is almost undetectable.

D. He should not receive flu vaccine until it can be proven he has outgrown his egg allergy.

Please leave your recommendation/comments below.

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