Management of Serious Side Effects After Flu Vaccination in Children

Recognition and Management of Anaphylaxis

The Centers for Disease Control and Prevention recommends recognizing anaphylaxis following influenza vaccination by signs and symptoms including respiratory symptoms: difficulty breathing, wheezing, stridor, cardiovascular symptoms: hypotension, tachycardia, skin manifestations: urticaria, angioedema, flushing, and gastrointestinal symptoms: nausea, vomiting, abdominal pain 1
Supportive measures for anaphylaxis include placing the patient in a supine position with legs elevated unless respiratory distress is present, activating emergency medical services, establishing and maintaining airway, administering high-flow oxygen if available, and establishing intravenous access for fluid resuscitation 3

Continuous monitoring of vital signs and observation for at least 4-8 hours after symptom resolution due to risk of biphasic reactions is recommended 3
For children who have experienced anaphylaxis after influenza vaccination, referral to an allergist for evaluation is essential, and skin testing or in vitro testing may help identify the specific component causing the reaction 4
Consider alternative influenza vaccine formulations based on the suspected allergen, such as cell culture-based (ccIIV) or recombinant (RIV) vaccines for egg allergy 5

For children with previous anaphylaxis to egg-based influenza vaccines, consider cell culture-based (ccIIV) or recombinant (RIV) vaccines under medical supervision, and vaccination should occur in a medical setting with personnel and equipment available to manage anaphylaxis 6

Though extremely rare in children, if Guillain-Barré Syndrome (GBS) is suspected, immediate neurological consultation is required, and hospitalization for monitoring and supportive care is necessary 7
For severe local reactions, cool compresses to reduce swelling, and pain management with acetaminophen or NSAIDs are recommended 2

All vaccination providers should be familiar with their office emergency plan and be certified in cardiopulmonary resuscitation, and all vaccines should be administered in settings where personnel and equipment for rapid recognition and treatment of anaphylaxis are available 3
The benefits of influenza vaccination generally far outweigh the risks for most children 1