Red Group - High Risk. Patients who have a history of an anaphylactic reaction to egg ingestion or flu vaccination should be evaluated by an allergist. Even patients who have then gone on to tolerate the vaccine later in life should be evaluated by an allergist, as there is significant year-to-year and lot-to-lot variability in the egg protein concentration in the flu vaccine. We recommend that these patients be skin tested to egg and full-strength inactivated flu vaccine prior to administration. Patients with negative skin tests to the vaccine would receive a graded flu vaccine challenge, while patients with positive skin test to the vaccine would receive either desensitization or neuraminidase inhibitor prophylaxis for the entire flu season.

Gray Group - Special Risks. Patients with immunodeficiency or other contraindications to either of the flu vaccines should be evaluated by an allergist or infectious disease specialist, and their close contacts and caregivers should strongly consider inactivated (i.e. not live) influenza vaccination. Most patients in this group may safely receive the inactivated flu vaccine as a single injection, provided they do not have a history of skin test positivity, serum IgE positivity, or clinical reaction to either egg or prior flu vaccines. Should a patient with immunodeficiency have such an issue, we would treat them similarly to whichever Green, Yellow or Red Group they would otherwise be in, with the general caveat that we do not recommend live vaccine use in this patient population or in pregnant women.

"It is the consensus of most allergists that flu shots can be given to virtually every patient who needs them if the proper procedure is followed," Dr. Lanier said.

Source: University of North Texas HSC in Fort Worth