Immune response to influenza vaccination in children and adults with asthma: effect of corticosteroid therapy.

Abstract

BACKGROUND:

Annual influenza vaccination is currently recommended as a preventative measure for all patients with asthma. However, the effect of maintenance corticosteroid therapy on the immune response to influenza vaccine has received limited evaluation.

OBJECTIVE:

In this study, we evaluated the effect of corticosteroid therapy on the immune response to influenza vaccine in children and adults with asthma.

METHODS:

This was a substudy of a larger multicenter, randomized, double-masked, placebo-controlled, crossover study investigating the safety of trivalent influenza vaccine in patients with asthma. At baseline, 294 subjects were randomized to receive either placebo first (n=139) or inactivated trivalent split-virus influenza vaccine first (n=155). Study subjects were categorized into 2 groups: subjects in group 1 (n=148) were receiving medium-dose or high-dose inhaled corticosteroids (ICSs) or oral corticosteroids, whereas subjects in group 2 (n=146) were not receiving corticosteroids or were receiving low-dose ICSs. Serum hemagglutination inhibition antibody titers for the vaccine antigens were measured before and 4 weeks after the administration of placebo or vaccine.

RESULTS:

Serologic responses to each influenza vaccine antigen were significantly higher in vaccine than in placebo recipients and were similar among influenza vaccine recipients in groups 1 and 2 for the following endpoints: rise in antibody titer, percent of participants who developed a serological response, and percent of subjects who developed a serum hemagglutination inhibition antibody titer > or =1:32. Post hoc subgroup analyses demonstrated an attenuated response to influenza B antigen in subjects receiving high-dose ICS compared with subjects who were steroid-naïve (P<.05).

CONCLUSION:

The immune response to the A antigens of the inactivated influenza vaccine in subjects with asthma is not adversely affected by ICS therapy. High-dose ICS therapy may diminish the response to the B antigen of the vaccine, an observation that needs further investigation.

• Authors: Nicola A Hanania, Marianna Sockrider, Mario Castro, Janet T Holbrook, James Tonascia, Robert Wise, Robert L Atmar, American Lung Association Asthma Clinical Research Centers
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 113 Issue 4 Pg. 717-24 (Apr 2004) ISSN: 0091-6749 [Print] United States
• PMID: 15100679 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Antigens, Viral
• Influenza Vaccines
• Placebos

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Antibody Formation (drug effects)
• Antigens, Viral (immunology)
• Asthma (drug therapy, immunology)
• Cross-Over Studies
• Double-Blind Method
• Female
• Humans
• Influenza Vaccines (immunology, therapeutic use)
• Influenza, Human (prevention & control)
• Male
• Middle Aged
• Placebos
• Vaccination