Dabigatran with mechanical heart valves?

This week, the RE-ALIGN study was published in the New England Journal of Medicine, examining the use of dabigatran in patients undergoing a mechanical valve replacement or who underwent one at least three months earlier.  This study was a dose-finding study for dabigatran primarily looking at plasma trough concentrations in patients receiving 150-300 mg po bid depending on renal function (Yes, higher than doses used for atrial fibrillation).  The pharmacokinetic model used in the RE-LY study (the >18,000 patient study resulting in approval of dabigatran) was used to target certain trough concentrations and dabigatran titration was performed at prespecified intervals. 

Egg allergy and the 2013 Influenza vaccine

Let’s start with a patient case.  A 55 year old female patient is seen in clinic that has recently been diagnosed with COPD.  After suffering from influenza last year, she is now seeking the influenza vaccine.  Upon further questioning, the patient confirms she is allergic to eggs.  When she eats eggs, she develops hives but no other symptoms.  What can we tell her?