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

Nicola A. Hanania, Marianna Sockrider, Mario Castro, Janet Teresa Holbrook, James A Tonascia, Robert A Wise, Robert L. Atmar

Research output: Contribution to journalArticle

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 ≥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.

Original languageEnglish (US)
Pages (from-to)717-724
Number of pages8
JournalThe Journal of Allergy and Clinical Immunology
Volume113
Issue number4
DOIs
StatePublished - Apr 2004

Fingerprint

Human Influenza
Influenza Vaccines
Adrenal Cortex Hormones
Vaccination
Asthma
Antigens
Vaccines
Placebos
Therapeutics
Hemagglutination
Antibodies
Inactivated Vaccines
Serum
Cross-Over Studies
Steroids
Maintenance
Observation
Safety

Keywords

  • Antibodies
  • Asthma
  • Immune response
  • Influenza
  • Inhaled corticosteroids
  • Vaccination

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Immune response to influenza vaccination in children and adults with asthma : Effect of corticosteroid therapy. / Hanania, Nicola A.; Sockrider, Marianna; Castro, Mario; Holbrook, Janet Teresa; Tonascia, James A; Wise, Robert A; Atmar, Robert L.

In: The Journal of Allergy and Clinical Immunology, Vol. 113, No. 4, 04.2004, p. 717-724.

Research output: Contribution to journalArticle

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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 ≥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-na{\"i}ve (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.",
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AU - Tonascia, James A

AU - Wise, Robert A

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