TABLE 3. Influenza vaccine contraindications and precautions for persons with a history of severe allergic reaction to a previous dose of influenza vaccine* — United States, 2024–25 influenza season.

Vaccine (of any valency) associated with previous severe allergic reaction (e.g., anaphylaxis)	Available 2024–25 influenza vaccines
	Egg based IIV3s and LAIV3	ccIIV3	RIV3
Any egg based IIV or LAIV	Contraindication†	Precaution§	Precaution§
Any ccIIV	Contraindication†	Contraindication†	Precaution§
Any RIV	Contraindication†	Precaution§	Contraindication†
Unknown influenza vaccine	Allergist consultation recommended

Abbreviations: ACIP = Advisory Committee on Immunization Practices; ccIIV = cell culture–based inactivated influenza vaccine (any valency); ccIIV3 = cell culture–based inactivated influenza vaccine, trivalent; IIV = inactivated influenza vaccine (any valency); IIV3 = inactivated influenza vaccine, trivalent; LAIV = live attenuated influenza vaccine (any valency); LAIV3 = live attenuated influenza vaccine, trivalent; RIV = recombinant influenza vaccine (any valency); RIV3 = recombinant influenza vaccine, trivalent.

* Manufacturer package inserts and updated CDC and ACIP guidance should be consulted for additional information, including, but not limited to indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states.

^† When a contraindication is present, a vaccine should not be administered, consistent with the General Best Practice Guidelines for Immunization (Source: Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization; https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html). In addition to the contraindications based on history of severe allergic reaction to influenza vaccines that are noted in the table, each individual influenza vaccine is contraindicated for persons who have had a severe allergic reaction (e.g., anaphylaxis) to any component of that vaccine. Vaccine components can be found in package inserts. Although a history of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of egg-based IIV3s and LAIV3, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine, and that any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used (see Persons with a History of Egg Allergy).

^§ When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction, consistent with the General Best Practice Guidelines for Immunization (Source: Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization; https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html). Providers can consider using the following vaccines in these instances; however, vaccination should occur in an inpatient or outpatient medical setting with supervision by a health care provider who is able to recognize and manage severe allergic reactions: 1) for persons with a history of severe allergic reaction (e.g., anaphylaxis) to any egg-based IIV or LAIV of any valency, the provider can consider administering ccIIV3 or RIV3; 2) for persons with a history of severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, the provider can consider administering RIV3; and 3) for persons with a history of severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, the provider can consider administering ccIIV3. Providers can also consider consulting with an allergist to help determine which vaccine component is responsible for the allergic reaction.