Background: Concerns regarding allergic reactions to vaccines and promotion of allergic disease development by routine immunization contribute to incomplete immunization coverage among children. Methods: Recommendations on how to immunize children at heightened risk for allergies were developed based on published evidence retrieved by a literature search. After 6 consensus meetings, 17 evidence-based statements were issued. Results: Routine immunizations do not promote development of atopic dermatitis, asthma or hay fever. Children with these conditions should receive standard vaccines under standard conditions and a delay of routine immunization is not warranted. Children with only a cutaneous allergy to chicken eggs should receive measles, mumps, rubella vaccine under standard conditions and inactivated influenza vaccine under observation. Children with systemic allergic reactions to chicken eggs should be immunized by a physician experienced in recognition and treatment of allergic reactions in children. Skin tests are not recommended to predict anaphylactic vaccine reactions but as a tool to identify the most likely vaccine component after an anaphylactic reaction. If a further vaccine dose after an anaphylactic reaction to a vaccine or a component is needed and avoidance is not possible, higher safety standards in the hospital setting are recommended. Conclusion: A careful immunization policy allows safe immunization of nearly all children with allergic diseases.