Professional Comfort Zone

I recently took my girls to a nearby pharmacy so that we could all receive our annual flu shots.  However, I didn’t expect that the pharmacist would refuse giving the flu shot to one of my girls who has an allergic reaction to eggs.

I was pretty sure I have read that individuals with egg allergies should be safe to receive flu shots.  This recommendation has been around for the last few years. The pharmacist was aware that I was carrying an EpiPen. She was also aware that my girl has received a flu shot in the past, although it was given prior to the discovery of her allergy to  raw eggs. Yet she was not comfortable to give it and advised me to go to her family doctor for the flu shot.

Below is the most recent NACI statement:

NACI has concluded that egg-allergic individuals without other contraindications may be vaccinated against influenza with any product, without a prior influenza vaccine skin test and with the full dose. The vaccine may be given in any settings where vaccines are routinely administered (see Section IV for details). As with any vaccine product, vaccine providers should be prepared for and have the necessary equipment to respond to a vaccine emergency at all times. LAIV also appears to be well tolerated in individuals with a history of stable asthma or recurrent wheeze; however, it remains contraindicated for individuals with severe asthma (defined as currently on oral or high-dose inhaled glucocorticosteroids or active wheezing) or for those with medically attended wheezing in the 7 days prior to the proposed date of immunization. There are also additional contraindications for LAIV (see Contraindications and Precautions in Section II for details).

My daughter was already anxious because she heard us talking about “eggs” and was  fearful of receiving the flu shot. So when the pharmacist refused to give the flu shot to her, it really contraindicated my effort to encourage her to receive the flu shot.

As much as I was disappointed with the pharmacist, I also felt I needed to respect her decision, that she was not comfortable despite the recommendations and documented experience with giving flu vaccines to people with egg allergies.

But how do people get professionally comfortable with anything?

This is an area that is difficult to assess or measure. However it is well documented that any behavioural change in clinical practice is complex and involves various stages. In fact, the Canadian Institute of Health Research has endorsed the Knowledge Action (KTA) Framework that looks at the various activities for knowledge synthesis as well as activities for knowledge implementation. For a good read on this topic, I suggest that you check out this post.

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Going back to my experience, I am not sure what would help change her mind? Perhaps asking more questions about the nature of the allergic reaction, or simply discussing this challenge with other pharmacists.  I didn’t tell her I am a pharmacist. I didn’t want to play this card. But would she have been more at ease if she knew?

It is unfortunate. I really don’t think I have time to make an appointment to see my family doctor for the flu shot.

Thank you for reading my post!

 

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drugopinions

My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

2 thoughts on “Professional Comfort Zone”

  1. Thanks for the clarification about egg allergy. I must say i as a family physician forgot that when a patient recently asked me, and i suggested that the nasal vaccine would be reasonable. I now know better. Re severe asthma;Is it contraindicated in all severe asthma , or just severe asthmatics with egg allergy? I wasn’t clear about that.

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