Atopic dermatitis, vaccination

The period in which many patients develop atopic dermatitis (AD) coincides with the time of the first vaccinations. This implies a causal relationship between vaccination and the onset of AD (AWMF Guideline 2023). However, current meta-analyses do not indicate an increased risk of AD due to vaccinations, but even a protective effect of some vaccinations (BCG, measles) (Navaratna S et al. 2021).

However, vaccinations as well as other stimulators of the immune system (e.g. viral infections) can trigger flare-ups of atopic dermatitis. However, this is no reason to postpone necessary vaccinations in the long term (AWMF Guideline 2023). On the other hand, it may be advisable not to vaccinate patients during an acute eczema flare. For SarsCoV2 vaccinations, there are also no special restrictions for people with AD or other atopic diseases with AD (Pfaar O et al. 2021)

Allergic reactions to vaccines are generally possible. Possible allergens include both adjuvants and possible residues of hen's eggs in vaccines produced in hen's eggs. This applies to vaccines for which viruses are grown in hen's egg fibroblast cell culture (MMR vaccines, rabies and TBE) or in embryonated hen's eggs (influenza). Here the risk of allergic reactions is negligible Des Roches A et al. 2012; Howe LE et al. 2011). In the case of vaccines produced in chicken embryos (yellow fever), an allergic reaction is conceivable but rare.

At best, there is a marginally increased risk of vaccination reactions for atopic patients (Bohlke K et al. 2003). In general, vaccination responses to dead vaccines may be reduced when systemic immunosuppressants including JAK inhibitors are used, but there is usually no risk.

Vaccine responses to dead vaccines are not attenuated with dupilumab and tralokinumab (Blauvelt A et al. 2019; Merola JF et al. 2021)

Live vaccines must not be administered during systemic therapies with immunosuppressants and are also not permitted during therapy with dupilumab and tralokinumab.

1. AWMF guideline (2023) Atopic dermatitis. Editorially revised long version (version 4.4) posted; 26.09.2023. Retrieved from https://register.awmf.org/en/guidelines/detail/013-027
2. Blauvelt A et al. (2019) Dupilumab does not affect correlates of vaccine-induced immunity: A randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. Journal of the American Academy of Dermatology 80:158-167.
3. Bohlke K et al. (2003) Risk of anaphylaxis after vaccination of children and adolescents. Pediatrics 112:815-820.
4. Des Roches A et al. (2012) Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol 130:1213-1216.
5. Howe LE et al. (2011) Safe administration of seasonal influenza vaccine to children with egg allergy of all severities. Ann Allergy Asthma Immunol 106:446-447.)
6. Merola JF et al. (2021) Tralokinumab does not impact vaccine-induced immune responses: Results from a 30-week, randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. Journal of the American Academy of Dermatology 85:71-78.
7. Merola JF et al. (2021) Tralokinumab does not impact vaccine-induced immune responses: Results from a 30-week, randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. Journal of the American Academy of Dermatology 85:71-78.
8. Navaratna S et al. (2021) Childhood vaccination and allergy: A systematic review andmeta-analysis. Allergy 76:2135-2152.
9. Pfaar O et al. (2021) COVID-19 vaccination of patients with allergies and type-2 inflammation with concurrent antibody therapy (biologicals) - A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI) and the German Society for Applied Allergology (AeDA). Allergol Select 5:140-147.