Hypersensitivity/allergic reactions following immunisation can be classified as:

  • urticarial- a red, itchy skin rash often referred to as hives, which characteristically has a central raised white wheal surrounded by an area of redness
  • non-urticarial rash- skin changes that don’t involve hives
  • angioedema- swelling in the deeper layers of the skin
  • generalised allergic reaction- involving symptoms like vomiting and diarrhoea
  • anaphylaxis- a sudden onset and rapid progression of symptoms involving the skin, respiratory and/or cardiovascular systems.

Suspected hypersensitivity reactions, particularly non-urticarial skin rashes following immunisation, are common, however true vaccine allergy, where a person is contraindicated from being immunised with the same vaccine in the future, is rare (less than 1 case per million doses).

A true vaccine allergy can only be diagnosed after specialist consultation with a vaccine allergy specialist, often after specific testing is carried out.

For future vaccine advice in the setting of immunisation hypersensitivity/allergic reactions, referrals should be made to SAEFVIC. SAEFVIC staff may direct the referral to an immunisation specialist or alternatively to a vaccine allergy specialist.

Influenza vaccine and egg allergy

Based on prospective and retrospective studies of influenza vaccination in those with and without egg allergy (including egg anaphylaxis), the presence of egg allergy does not increase the risk of allergic reactions to the influenza vaccine.

The influenza vaccine can be administered in community vaccination clinics (which may or may not have direct medical practitioner supervision), General Practitioner surgeries or Immunisation clinics, as a single dose followed by the recommended 15 minute observation period.

MMR vaccine and egg allergy

Although measles and mumps vaccine viruses are cultivated in eggs, these vaccines (MMR or MMR-Varicella vaccines) contain negligible amounts of egg protein/allergen. Therefore individuals with allergy/anaphylaxis to egg can be safely immunised in the community setting without any need for extra monitoring or additional observation.

Yellow fever vaccine and egg allergy

Currently, many guidelines advise that egg anaphylaxis is a contraindication to receiving a yellow fever vaccine (YFV), with the Australian Immunisation Handbook recommending people requiring the vaccine discuss this with an immunologist or allergist due to the YFV containing egg ovalbumin.

Due to the serious nature of the disease, some countries requiring proof of immunisation as an entry requirement and the widely varying guidelines pertaining to YFV in egg-allergic people; researchers from the National Centre for Immunisation Research and Surveillance (NCIRS), and the Royal Children’s Hospital in Melbourne, have published a case series proposing that skin testing may not be required for patients with mild egg allergy, and that a 2-step graded challenge under medical supervision is a safe alternative.

COVID-19 vaccines and allergy

Additional precautions are recommended for individuals with possible allergic reactions to a previous dose of a COVID-19 vaccine; allergic reactions to ingredients in the COVID-19 vaccine to be administered (including Polysorbate 80 in Vaxzevria (AstraZeneca) and Nuvaxovid (Novavax), and PEG in Comirnaty (Pfizer) and Spikevax (Moderna)); prior anaphylactic reactions to other vaccines or medications where PEG or Polysorbate 80 may have been the cause; or a known systemic mast cell activation disorder with raised mast cell tryptase that has required treatment.

In these instances a specialist review by an immunology/allergy/vaccination specialist to undertake a risk/benefit assessment to assess suitability for vaccination should be undertaken.

For all other allergies, including those with a history of anaphylaxis to food, drugs, venom or latex, it is recommended a routine observation period of 15 minutes following COVID-19 vaccination is observed.

Author: Kirsten Perrett (Clinician Scientist Fellow, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)

Date: May 31, 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.