The Australian Immunisation Handbook 10th Edition 2013

elationship to vaccination, and determine if, and under what circumstances,
repeat doses of vaccine can be provided. Specialist advice should be sought
where appropriate (see above).
Vaccination of persons with a known egg allergy
Influenza vaccines
A history of anaphylaxis or a severe allergic reaction to eggs has previously been
considered an absolute contraindication to influenza vaccination. However,
there have now been a number of studies indicating that the majority of persons
with egg allergy, including anaphylaxis, can be safely vaccinated with influenza
vaccines that contain less than 1 μg of ovalbumin per dose8-10 (see 4.7 Influenza).
The majority of vaccine-associated anaphylaxis cases reported as likely due to
egg allergy occurred following administration of one of the older formulations
of influenza vaccine. 9 Today, due to manufacturing changes, the quantity of
egg ovalbumin present in the majority of influenza vaccines used in Australia
is less than 1 μg of ovalbumin per dose. 8 Note that the amount of residual egg
ovalbumin may vary from year to year due to manufacturing processes, vaccine
batches and country of origin. The PI of the vaccine to be given should be
checked for the vaccine’s ovalbumin content prior to vaccine administration. 8,9,11,12
Given that there is still a small risk of anaphylaxis, it is essential that persons
with a history of a severe allergic reaction to eggs are vaccinated in facilities that
have staff who are able to recognise and treat anaphylaxis. 8,9 Allergy testing (e.g.
skin testing) with influenza vaccine prior to administration is not recommended,
as there is poor correlation between test results and vaccine tolerance. 8,9 Detailed
information on influenza vaccination of individuals with an allergy to eggs
can be found in the Australasian Society of Clinical Immunology and Allergy
(ASCIA) guidelines8 (available at www.allergy.org.au/health-professionals/
papers/influenza-vaccination-of-the-egg-allergic-individual).
Other vaccines
Vaccines used in Australia that contain traces of egg ovalbumin, in addition to
most influenza vaccines, are:
• rabies vaccine, Rabipur (see 4.16 Rabies and other lyssaviruses (including
Australian bat lyssavirus))
• yellow fever vaccine, Stamaril (see 4.23 Yellow fever)
• Q fever vaccine, Q-Vax (see 4.15 Q fever).
Of these vaccines, yellow fever and Q fever vaccines contain a higher amount of
ovalbumin than is present in the currently available influenza vaccines and are
contraindicated in persons with known severe allergy to eggs. Persons with egg
allergy requiring vaccination with either yellow fever or Q fever vaccines should
seek specialist immunisation advice from state or territory health authorities
132 The Australian Immunisation Handbook 10th edition