This patient with a history of egg allergy should receive inactivated influenza vaccine (IIV). Although IIV is prepared using chicken eggs and contains a very small amount of egg protein, it has been shown to be safe in patients who have only experienced hives upon exposure to eggs, according to recommendations released by the Advisory Committee on Immunization Practices (ACIP). As a precaution, however, IIV should be administered in these patients by a health care professional who is trained to recognize the manifestations of egg allergy, and the patient should be observed for 30 minutes or longer for any signs of an adverse reaction. Since this patient has only experienced hives, not anaphylaxis, upon egg exposure, he may receive IIV.

Live attenuated influenza vaccine (LAIV) also contains only a small amount of egg protein; however, it is only approved to be administered to immunocompetent adults aged 49 years and younger without a history of any egg allergies, as it has not been extensively studied in patients with this allergy. Therefore, use of LAIV in this patient would not be appropriate.

Skin testing (either prick or intradermal) with influenza vaccine before vaccine administration is not recommended for patients with egg allergy because the presence of a positive skin test is not predictive of a subsequent systemic reaction. Skin testing with the vaccine may be appropriate for evaluation of patients with possible allergy to the vaccine itself, but not specifically egg allergy.

Influenza vaccination is recommended for all persons aged 6 months and older unless specifically contraindicated. As inactivated influenza vaccine can be safely administered to patients with a history of hives after exposure to egg, it is inappropriate to avoid vaccinating this patient against influenza.

Recombinant influenza vaccine (RIV) is produced using recombinant DNA technology, does not contain egg proteins, and can be used in patients with severe egg allergy (such as those who experience anaphylaxis). However, it would not be necessary in this patient who is a candidate for routine IIV administration.