Physician compliance with updated practice parameters for influenza vaccination in individuals with egg allergies

Background: Significant recent changes to the recommendations in providing trivalent seasonal influenza vaccine (TIV) to individuals with egg allergy were made, but their implementation has not been studied.

Objectives: To investigate allergist-reported compliance with updated TIV administration guidelines for individuals with egg allergy.

Methods: A 22-question electronic survey was distributed via e-mail to American Academy of Allergy, Asthma, and Immunology members (allergists), which queried practice styles and attitudes that pertain to TIV administration to individuals with egg allergy.

Results: Only 1% of 895 respondents believed that TIV should be contraindicated for individuals with egg allergy, 3.8% reported not administering TIV to individuals with egg allergy, and 17% reported only administering TIV to individuals with mild egg allergy; 13.2% reported that risk-mitigating precautions (eg, vaccine skin testing, graded-dose challenges) were necessary. Postimplementation change compared with preimplementation change included less intradermal testing (30.6% vs 64.9%), less multistep desensitization (34.7% vs 65.3%), observing more patients for >30 minutes after vaccination (79.1% vs 20.9%), administering TIV despite positive TIV skin tests (65.4% vs 34.6%) (all P < .001), but no significant reduction in performing TIV prick skin testing (46.2% vs 53.8%). Factors associated with not performing TIV skin testing included reading the guidelines (P = .028), academic practice (P < .01), and fewer years in practice (P < .01). Only 48.6% agreed that TIV can safely be administered in the primary care setting to individuals with egg allergy, and only 41.9% advised their patients accordingly.

Conclusion: There were significant shifts in practice style over time concurrent with newly established guidelines, except for vaccine skin testing. Physician opinions are also concurrent with guideline changes. Although TIV administration guideline recommendations are being successfully implemented, greater adherence should be promoted.