A 2-year-old girl with a history of severe allergic reaction (anaphylaxis) to egg protein following MMR vaccination 6 months ago is brought for routine immunisation. Her parents are concerned about future vaccinations. According to IAP guidelines, which vaccine can be safely administered to this child at the next visit?

## Egg Allergy and Vaccine Safety: IAP Guidelines **Key Point:** The severity of egg allergy determines vaccine eligibility. Anaphylaxis to egg is a contraindication to egg-containing vaccines, but the child can safely receive non-egg-derived vaccines and, with precautions, some egg-containing vaccines under medical supervision. **High-Yield:** Hepatitis A vaccine is produced in human diploid cells (HDC) or fetal rhesus kidney cells and does NOT contain egg protein. It is safe for children with severe egg allergy and is part of IAP's recommended immunisation schedule. ### Vaccines and Egg Content Classification | Vaccine | Egg Content | Status in Severe Egg Allergy | | --- | --- | --- | | **MMR/MR** | High (grown in eggs) | **CONTRAINDICATED** — risk of anaphylaxis | | **Japanese Encephalitis (Vero)** | Moderate (Vero cells, some egg) | **RELATIVE CONTRAINDICATION** — safer than MMR but risk exists | | **Hepatitis A** | **None** (HDC/FRK cells) | **SAFE** — no egg protein | | **Yellow Fever** | High (grown in eggs) | **CONTRAINDICATED** — anaphylaxis risk | | **Influenza (egg-derived)** | High | **CONTRAINDICATED** — anaphylaxis risk | | **Polio (IPV)** | None | **SAFE** | | **DPT/Pentavalent** | None | **SAFE** | | **Hepatitis B** | None | **SAFE** | **Clinical Pearl:** If a child with severe egg allergy requires an egg-containing vaccine (e.g., MMR for an outbreak), it can be given under medical supervision in a setting equipped to manage anaphylaxis, with epinephrine readily available. However, non-egg alternatives should be preferred. **Mnemonic: EGG ALLERGY VACCINES** — **E**gg-free vaccines (Hep A, IPV, DPT) = SAFE; **G**reat caution with egg-containing (MMR, JE, YF); **G**ive alternatives when possible. ### Management Algorithm for This Child ```mermaid flowchart TD A[2-year-old with anaphylaxis to MMR]:::outcome --> B{Which vaccine to give?}:::decision B -->|Egg-containing<br/>MMR, YF, JE| C[CONTRAINDICATED<br/>or relative CI]:::urgent B -->|Egg-free<br/>Hep A, IPV, DPT| D[SAFE - Give as scheduled]:::action C --> E[Consider under medical<br/>supervision if essential]:::action D --> F[Complete routine schedule]:::outcome ``` **Tip for Exam:** When a question mentions severe egg allergy and anaphylaxis, immediately eliminate all egg-containing vaccines (MMR, YF, influenza). Hepatitis A is a high-yield answer because it is safe AND part of IAP's recommended schedule.