title: 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).
  
  
  CONCLUSIONS
  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.affiliation: Pulmonary and Critical Care Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA. Hanania@bcm.tms.edu
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Hanania
authors.forename: Marianna
authors.initials: M
authors.lastname: Sockrider
authors.forename: Mario
authors.initials: M
authors.lastname: Castro
authors.forename: Janet T
authors.initials: JT
authors.lastname: Holbrook
authors.forename: James
authors.initials: J
authors.lastname: Tonascia
authors.forename: Robert
authors.initials: R
authors.lastname: Wise
authors.forename: Robert L
authors.initials: RL
authors.lastname: Atmar
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000917:Antibody Formation / Q000187:drug effects; D000956:Antigens, Viral / Q000276:immunology; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000276:immunology / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D014611:Vaccination
chemical_list: D000305:Adrenal Cortex Hormones; D000956:Antigens, Viral; D007252:Influenza Vaccines; D010919:Placebos