Influenza and Eggs: Don't Lose Face
What is the CDC's new guidance on influenza vaccination and egg allergy? Make sure you don't find out from a patient.
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Given the contemporary patient’s penchant for searching the Internet (even sometimes the good sites) for health information and the seemingly never-ending changes in recommendations by “experts,” it is almost inevitable that at some point you will say something to a knowledgeable patient only to find yourself being corrected. Here’s a potential scenario: the CDC has published new recommendations (September 2016) regarding the influenza vaccine and patients with egg allergy. So, before you make a wrong recommendation to a patient and end up with egg on your face, be sure you are familiar with the latest information.
But before you click on the CDC link above, try these 3 questions to see what you might know already.
An otherwise healthy 35-year-old woman is in your office and asks about a flu vaccination. She has had a severe egg allergy for decades and two months ago needed epinephrine and IV fluids in the ER for an accidental exposure.
1. About the flu vaccination, you tell her:
A. Since you are in a low-risk group for influenza complications, the risk of getting a flu vaccine exceeds the benefit, so don’t get vaccinated.
B. You can receive any of the various flu shots but will need to wait in the office for 30 minutes after receiving a vaccine made in chicken eggs.
C. You should only receive Flublok, the flu vaccine made without eggs. But since I don’t have it in my office, you’ll have to go elsewhere to receive it.
D. None of the above is true.
Answer: D. None of the above is true
This patient, according to the CDC, can receive any of the flu vaccines available and does not even need to wait in your office for any length of time. Last season, the correct answer would have been B. The CDC estimates that the rate of anaphylaxis following an influenza vaccination is 1.35 per million doses, a rate similar to many other vaccines. Flublok would, of course, be very safe to use, but the CDC strongly discourages not vaccinating someone for flu with whatever approved vaccine you have in the office. Lots of patients who delay getting the vaccine end up not getting it at all.
2. Flumist is essentially off the market this year. But, what is the CDC’s stance on its use in an egg-allergic patient?
A. OK to use in any egg allergic patient.
B. OK to use in an egg-allergic patient only if a previous reaction was hives without anaphylaxis.
C. Not OK to use, unlike the shot vaccines, due to data suggesting an increased risk of reaction.
D. Not OK to use, unlike the shot vaccines, due to a lack of data for FLumist as compared to the shot forms.
Answer: A. OK to use in an egg-allergic patient.
Last season, the correct answer regarding Flumist use in an egg-allergic patient would have been option D. Not OK to use due to lack of comparative data.
The CDC does recommend that egg-allergic patients receive their vaccine in a medical facility, including private offices and clinics, with a “health care provider” who can recognize and treat a severe allergic reaction. I interpret this as precluding pharmacist-administered vaccine.
Bonus question for the curious: Where and when did the saying “egg on your face,” meaning you are embarrassed for making a mistake, originate?
A. This is yet another saying attributed to Shakespeare in one of his comedies, so early 1600’s.
B. First recorded in 18th century England initially referring to actors pelted with eggs and tomatoes for a bad performance
C. First recorded in 19th century USA referring to politicians pelted with eggs and tomatoes for saying unpopular things
D. Thought to have started in the USA during the 1950’s from someone being a messy eater and ending up with some embarrassing ”egg on their face.”
According to the Random House Dictionary of American Slang, the correct answer is D. Who would have guessed that this “old saying” isn’t very old?
References:
CDC. Flu Vaccine and People with Egg Allergies. Accessed Nov 8 and available at: http://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm
Origin of getting egg on one's face: https://www.quora.com/What-does-caught-with-egg-on-your-face-mean-and-what-is-its-origin
