Is the flu nasal spray safe for egg allergy?

It’s that time of year again – flu season! No-one wants to suffer through flu and it can be particularly dangerous for people with lowered immune systems,pregnant women or people with other medical conditions like asthma. In terms of allergy, I see a a lot of confusion about one question: Is the flu nasal spray safe for egg allergy?

Both my children have egg allergies and cannot tolerate baked egg, yet I have allowed them to have the flu nasal spray for the past four years and will do so again this year.

Here’s why: The flu nasal spray is considered safe for egg allergy.

How do you know the flu nasal spray is safe for egg allergy?

The Sniffle Study looked at whether the amount of egg in the flu nasal spray (also called LAIV or Fluenz) was enough to cause a reaction. They recruited over 300 children diagnosed with an egg allergy, 115 of whom had prior anaphylaxis and 186 with a history of asthma.

They found that none of the children had a systemic or anaphylactic reaction to the nasal spray. 8 children had mild reactions and 26 had some coughing or wheezing within 3 days.

What about children with severe egg allergies?

A lot of the literature says children with severe egg allergies should avoid the nasal spray but doesn’t clarify what this means. The guidance based on the study is that, for precaution, any child that has been in intensive care due to an anaphylactic reaction to egg should talk to their allergist about having it in a hospital setting.

Can egg allergic children have the flu nasal spray at school?

Yes, it is safe for them to have it at school, nursery or at the GP.

What about the flu injection?

The standard flu injections also contain low levels of egg protein.

Isn’t there an egg free flu injection?

In 2019, there is an egg free flu injection (called Flucelvax or QIVc) but it is only suitable for children over 9 years old.

Is asthma a risk factor?

Children with asthma are safe to have the flu nasal spray or injection. They should not have it if they are currently taking oral steroids, have been prescribed them in the last 14 days or have had active wheezing or increased use of their inhalers in the last 72 hours.

Is there any risk of anaphlaxis?

People can be allergic to other components of the flu vaccine which can cause anaphylaxis, although this is rare.

I hope that helps clear up any questions you may have about whether the flu nasal spray or injection are safe with an egg allergy. It is parental choice whether you vaccinate your children but I strongly believe that for the safety of my children, especially the adverse effects it would have on J’s asthma, and for the safety of other children with compromised immune systems, it is important to do so.

I am not a trained medical expert so for more personalised guidance please talk to your allergist. The information on this page is based on the following medical journals and references:

Anaphlaxis campaign: https://www.anaphylaxis.org.uk/2015/07/20/sniffle-study-finds-nasal-flu-vaccine-appears-safe-for-egg-allergic-and-asthmatic-children/

British Society Of Allergy And Clinical Immunology:

https://www.bsaci.org/Guidelines/Flu%20jab%20egg%20allergic%20kids.pdf

Inlfluenza: the green book, Public Health England:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/733840/Influenza_green_book_chapter19.pdf

British Medical Journal: https://www.bmj.com/content/351/bmj.h6291

Influenza vaccines for 2019-2020 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/814097/PHE_Influenza_ovalbumin_content__table_2019_2020.pdf