Immune response to influenza vaccination in children and adults with asthma: Effect of corticosteroid therapy
Immune response to influenza vaccination in children and adults with asthma: Effect of corticosteroid therapy
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DOI：
10.1016/j.jaci.2003.12.584
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发表时间：
2004-04-01
影响因子：
14.2
通讯作者：
Atmar, RL
中科院分区：
文献类型：
--
作者：
Hanania, NA;Sockrider, M;Atmar, RL
背景：目前推荐每年接种流感疫苗作为所有哮喘患者的预防措施。然而，维持皮质类固醇治疗对流感疫苗免疫应答的影响得到了有限的评价目的：在这项研究中，我们评估了皮质类固醇治疗对儿童和成人哮喘患者流感疫苗免疫应答的影响。这是一项大型多中心、随机、双盲、安慰剂对照的子研究，交叉研究，调查三价流感疫苗在哮喘患者中的安全性。在基线时，294名受试者被随机分配为首先接受安慰剂（n = 139）或首先接受灭活三价裂解病毒流感疫苗（n = 155）。研究受试者分为2组：第1组受试者（n = 148）正在接受中剂量或高剂量吸入性皮质类固醇（ICS）或口服皮质类固醇，而第2组受试者（n = 146）未接受皮质类固醇或正在接受低剂量ICS。血清血凝抑制抗体滴度的疫苗抗原前和4周后，安慰剂或vaccine.Results管理：血清反应，每种流感疫苗抗原显着高于安慰剂接受者，并在流感疫苗接受者之间相似的第1组和第2组的以下终点：抗体滴度升高、出现血清学应答的受试者百分比和出现血清血凝抑制抗体滴度大于或等于1：32的受试者百分比。事后亚组分析表明，与未接受过激素治疗的受试者相比，接受高剂量ICS的受试者对流感B抗原的应答减弱（P <0.05）。结论：哮喘受试者对灭活流感疫苗A抗原的免疫应答不受ICS治疗的不利影响。高剂量ICS治疗可能会降低对疫苗B抗原的反应，这一观察结果需要进一步研究。
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-close 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 greater than or equal to1:32. Post hoc subgroup analyses demonstrated an attenuated response to influenza B antigen in subjects receiving high-dose ICS compared with subjects who were steroid-naive (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.