Vaccine allergy & reaction evaluation

Phenotype a vaccine reaction or pre-vaccination allergy concern and decide who can be vaccinated normally vs who needs allergist evaluation/excipient testing. Bakes in the corrections that egg allergy is NOT a contraindication to influenza/MMR and that local or delayed reactions are not contraindications.

Evidence tier: Guideline-derived.

Decision points

  • What is the scenario?
  • Which best fits the reaction?
  • Which component is the concern?

Do-not-miss pitfalls

  • Do not withhold influenza or MMR vaccine for egg allergy, it is not a contraindication.
  • Do not treat a large local injection-site reaction or a delayed rash as an allergy contraindication.
  • Do not assume the antigen is the culprit, most IgE-type vaccine reactions are to excipients.
  • Do not over-rely on a negative excipient skin test to exclude allergy, nor on a positive (possibly irritant) result to diagnose it.
  • Do not broadly defer all vaccines after one reaction without phenotyping and allergist input.

Evidence & citations

  1. Kelso JM, Greenhawt MJ, Li JT, et al. Adverse reactions to vaccines practice parameter 2012 update. J Allergy Clin Immunol. 2012;130(1):25-43. PMID 22608573
  2. Greenhawt M, Shaker M, Golden DBK, et al. Diagnostic accuracy of vaccine and vaccine excipient testing in the setting of allergic reactions to COVID-19 vaccines: a systematic review and meta-analysis. Allergy. 2023;78(1):71-83. PMID 36321821

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.