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Case 3: 65-Year-Old Male Patient With An Egg Allergy


Drs Jacinda Abdul-Mutakabbir and Charles Vega share their expertise on how to vaccinate a 65-year-old male patient with an egg allergy.

John Russell, MD, FAAFP: [This is] the last case to run through this gantlet of intellectuals and see if we can kind of work out a best-case scenario for this patient. So, it's a 65-year-old male patient. He's coming into the office for a routine wellness check, and flu season is coming. So, we want to talk with him about flu vaccine. He does have a history of a significant egg allergy, and he's traditionally been someone who has not [been] getting flu vaccines because he has a real concern about the egg components in the manufacturing process. He decides to go to his local pharmacy to get a vaccine and see what options are available to him. His doctor did not have an egg-free option for him, so [he] kind of moved on to the pharmacy. So, JAM, he kind of enters into your space, 65-years-old, has a significant egg allergy, how are you having him walk through some of the options that he could have at your shop?

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP: Absolutely. So, first and foremost, I'm excited that he wants to be vaccinated after not being able to receive it. But then, too, I think that…now we can walk through the available options to him and just the CDC’s [Centers for Disease Control and Prevention] recommendation. So, the CDC's recommendation is, even if you have an egg allergy, it is still the expectation, it is still the recommendation that you do receive the vaccine. So, if a person has always experienced hives, then you go ahead and you get that vaccine, [if] you are in a pharmacy or let's say that it wasn't this particular person and they were in a PCP [primary care physician] office. There are therapeutics that we can give in the event that hives were to happen, we can give Benadryl. You know, if the patient experiences those hives again, we can get around that egg allergy. But also, the good thing for this patient is that we have options that do not have egg in them. So, there's also something that I can recommend to the patient. Considering that he's 65 years and older, the recombinant vaccine is definitely an option for him. We also have cell-based vaccines that can be an option for him. But also, it is the recommendation that if you are somebody that has an egg allergy and if you've had anything other than hives, you are still to get a flu vaccine. And then, what we'll do, is we'll just make sure that if anything odd happens, that we're there to protect, you know, this patient when he comes in. Nonetheless, to sum this up, there are several options that we could talk to him about. There are several things that he could do in terms of receiving the flu vaccine. But more importantly, per the CDC recommendation, the egg allergy does not disqualify him from getting a vaccine. The good thing about going to the pharmacy is that, I think, that Chuck did a really good job saying that, you know, in his office he only has 2 vaccines. The pharmacy may have a lot more. So, when he comes into the pharmacy then he will likely have a lot more options available to him.

John Russell, MD, FAAFP: So, Chuck, we just heard that this patient, even if he had a severe egg allergy, could receive a vaccine such as the Flublok vaccine, the recombinant vaccine. But, you know, when someone's had an egg allergy, sometimes it's hard to unpack that. How you go about unpacking that and explaining that there are egg-free technologies?

Charles Vega, MD, FAAFP: Oh, yeah. I want to unpack it and I want to unpack it a lot because egg allergy means a lot of different things to different people. So, what was the severe egg allergy? The most common response I get is “I don't remember. I don't know exactly what happened.” The other common response I get is “I got really sick.” Okay, tell me more about that. “I threw up a bunch of times.” That's not IgG mediated. It's not an allergic reaction. So, I think that by just in an iterative process, respectfully asking yeah, we can actually remove egg and a lot of other allergies from patients’ history which just lets them lead more full lives and gets vaccine in arms and a bunch of other good things happen. So, but if I do have a patient with a history of anaphylaxis and it's documented, we know that, and the patient is sure of this, and I am going to think about using a cell-based vaccine that's never touched eggs. It's important for their peace of mind. It's important potentially if they had a severe case of anaphylaxis, that that could be a safer option for them as well, where we don't necessarily have to think about, we might actually have to use emergent epinephrine or worry about an airway. That's not something that we do in our clinic on any kind of routine basis. Our turn to the peace of mind, though, for folks who have a more mild allergy, but they're really worried about it, again, with the concept of “Let's just get vaccines in arms.” I still think that that that cell-based vaccine is a good go-to for patients who are just worried and I know that just won't accept an egg-based vaccine. So, with that principle, the cell-based vaccine is a better choice.

John Russell, MD, FAAFP: So, Wendy, if this patient, [aged] 65, doesn't have an egg allergy, what are the 3 preferential recommendations for him for a flu vaccine?

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: So, all of my colleagues have done such a great job, but for that 65 [years] and up, who doesn't have an egg allergy, you don't have to worry about using, for instance, the high-dose flu [vaccine], which is an egg-based vaccine. You've got your recombinant [vaccine] you've got your adjuvanted [vaccine], but at the end of the day, if you have none of those available, give them a standard vaccine. 100% of 0 is still 0. So, we know that there are prioritized vaccines, but at the end of the day, if you don’t have them available, give them a flu shot.

Transcript is AI-generated and edited for clarity and readability.

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