People with egg allergies in Canada are getting a green light to get flu shots.
A panel of experts which issues advice on which vaccines Canadians ought to get has changed its stance on flu shots and egg allergies.
Flu vaccine is made in chicken eggs and people allergic to eggs have long been told they should forgo the annual shots.
But a series of recent studies have looked at the issue and have found the shots can be safely given to people with egg allergies.
The new advice from the National Advisory Committee on Immunization relates to injectable flu shots only (the form of flu vaccine most commonly given in Canada).
The panel says there isn't enough evidence at this time to determine whether the nasal spray flu vaccine – a live virus vaccine sold as FluMist – is also safe for people with egg allergies. But it notes a study is under way looking at that question.
The new advice is contained in NACI's 2011-2012 statement on seasonal flu immunization.
It suggests that doctors don't need to give people with egg allergies a skin test first to see if they can tolerate the vaccine. Instead, they suggest one of two options for people with egg allergies, depending on their individual risk of having a severe reaction to egg protein.
People with a lower risk of a severe reaction can be given the vaccine in a single dose, but should be observed for 30 minutes after getting the shot in case a reaction develops, the statement says.
People who are at higher risk of reacting should be given one-tenth of the volume of the appropriate flu shot for their age and watched for 30 minutes to see if they react. If they do not, or if the reaction resolves itself, they can be given the remainder of the shot, the NACI statement says.
People who develop a sustained or severe reaction to the partial shot shouldn't get the second shot, the statement advises.
"Referral to a specialist with expertise in allergies may be necessary in occasional circumstances where there is strong concern about proceeding with the recommendations above and the individual is at risk of complications from influenza," the panel notes.
"If the [egg-allergic]individual is not in a high-risk group, the need for vaccination may be reassessed."
This year's flu vaccine statement from NACI contains a few other changes as well.
The group is advising that toddlers aged six to 35 months be given a full dose of flu vaccine – instead of the previous half dose – because evidence suggests it stimulates a better immune response without increasing the level of reactions to the vaccine.
But this year's statement drops NACI's recommendation that provinces and territories should give "special consideration" to providing free flu shots to children aged two to four years, if a universal program is not in place.
In the wake of the 2009 pandemic, last year NACI suggested provinces and territories make an exception and offer free flu shots to some groups which normally don't make the "high risk" list.
This year's statement drops the special considerations category, saying vaccine programs should focus on people who are either at high risk of developing severe complications from flu, people who live with or care for people who fall into the first category – someone who looks after the elderly, for instance – and people who provide essential community services.
The statement says flu shots are encouraged for all healthy children and adults between ages two and 64, but it doesn't ask the provinces and territories to pay for them.
In many places, though, this change is moot. Eight provinces and territories offer free flu shots to all residents six months and older. Children under the age of six months are not given flu vaccine.
Two other groups from the special consideration category have been added to NACI's list of people considered at high risk of complications from a bout of influenza. As a result, provinces and territories are being advised to offer free flu shots to people who are morbidly obese (with a body mass index of 40 or over) and First Nations people.
The Canadian Press