All vaccines can be associated with minor reactions, including pain and redness at the injection site, headache, fatigue, or discomfort (45). Injection site reactions, including redness, swelling, induration, and itching, are more common with the TIV intradermal vaccine than with the intramuscular formulations; these reactions resolve within 3 to 7 days. Other transient side effects of intradermal vaccine include headache, muscle ache, and tiredness (6,42,43). The most common adverse events reported with LAIV are runny nose or nasal congestion in all ages, fever >100ºF in children aged 2 to 6 years, and sore throat in adults (46).
Allergic reactions: Allergy to egg protein is not an absolute contraindication to administration of TIV when proper precautions are taken, and it must be distinguished from allergy to influenza vaccine. Patients reporting less severe egg allergy, that is, those who can eat lightly cooked egg (eg, scrambled egg) without reaction, can receive TIV per the usual protocol. Patients who have previously experienced only hives after eating eggs or foods containing eggs can also receive TIV (not LAIV), but must be observed for at least 30 minutes afterward for signs of a reaction. There is no need to divide doses or perform skin testing prior to administration (6). Severe allergic reactions to influenza vaccine are rare. A previous severe allergic reaction to influenza vaccine is always a contraindication to receipt of vaccine, regardless of the component suspected responsible for the reaction (6). Patients who have experienced severe symptoms, such as cardiovascular changes (eg, angioedema), respiratory distress, lightheadedness, gastrointestinal reactions (eg, nausea, vomiting), or who required epinephrine or other emergency medical intervention after egg exposure, are more likely to have a serious systemic or anaphylactic reaction upon reexposure to egg proteins and should be referred to a physician with expertise in managing allergic conditions for further evaluation (6).
All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available (6).