Vaccines

Background

It is estimated that any adverse effect from vaccines occurs in 11.4 per 100,000 administrations.

The most common vaccine adverse reactions are fever and local injection site reactions–which are not hypersensitivity reactions and are not contraindications to future vaccination.

The reported incidence of anaphylaxis is 1.3 case per million doses.

No, egg allergy is not a contraindication to receiving the influenza vaccine.

The amount of egg protein (ovalbumin) is not sufficient (< 1 µg) to provoke a reaction even in the recipients with most severe egg allergy.

Skin Testing

Management

Reaction Type Perform Skin Testing? Vaccine Administration by Skin Testing Result (if applicable)
Delayed reaction (e.g. late-onset urticaria, local arm swelling) No Subsequent dose in usual manner
Immediate reaction without IgE-mediated reaction features (e.g. tingling, flushing, palpitation, sensation of throat closure) No Subsequent dose in usual manner but observe for 30 minutes
Immediate reaction with IgE-mediated reaction features (e.g. urticaria, angioedema, wheezing) Yes

Negative: Usual manner 30 min obs

Positive: Split dose
Anaphylaxis Yes

Negative: Split dose

Positive: Graded dose
Protocol for vaccine split dose administration
Step Volume (mL) of full-dose full-strength for 0.5 mL vaccine dose Dilution Percent of full-dose full-strength for 0.5 mL vaccine dose Observation
1 0.05 Full-strength 10% 30 minutes
2 0.45 Full-strength 90% 30 minutes
Protocol for vaccine graded dose administration
Step Volume (mL) Dilution Percent of full-dose full-strength Observation
1 0.05 1:10 N/A 15 minutes
2 0.05 Full-strength 10% 15 minutes
3 0.1 Full-strength 20% 15 minutes
4 0.15 Full-strength 30% 15 minutes
5 0.2 Full-strength 40% 15 minutes