title: Pneumococcal seroconversion after vaccination for children with atopic dermatitis treated with tacrolimus ointment.
abstract: OBJECTIVE
  We sought to determine the effect of treatment with topical tacrolimus on B- and T-cell immunity including the primary antibody response to pneumococcal polysaccharide vaccine in children with atopic dermatitis.
  
  
  METHODS
  In this open-label, noncomparative study, 23 children aged 2 to 12 years with moderate to severe atopic dermatitis were treated with tacrolimus 0.03% ointment twice daily for 7 weeks, immunized with a 23-valent pneumococcal polysaccharide vaccine after 3 weeks of treatment, and had their antibody response measured (for 12 pneumococcal serotype antigens present in the vaccine) before and 4 weeks after vaccination. None had received pneumococcal vaccine before the study. Patient antibody and cellular immune responses were assessed at each study visit (baseline, week 3, and week 7).
  
  
  RESULTS
  No significant changes in complete blood cell count, lymphocyte subsets, CD4/CD8 ratio, immunoglobulin levels, antibody titers to tetanus and Haemophilus influenzae , or lymphoproliferative responses were noted during the tacrolimus ointment treatment period. Tacrolimus blood levels were 1 ng/mL or less in all 23 children. Protective pneumococcal titers to all 12 serotypes were observed in 2 of 23 (9%) children prevaccination and in 16 of 23 (70%) children postvaccination. All 6 children who had protective titers to 0 to 5 of the 12 serotypes developed protective titers to an additional 5 to 11 serotypes. Of the patients, 91% had a greater than 4-fold increase in titer for at least 4 of 12 pneumococcal serotypes.
  
  
  CONCLUSIONS
  Topical application of tacrolimus ointment does not affect the serologic response to pneumococcal vaccine or interfere with preexisting T- and B-cell immune responses.
authors: Mattel Children's Hospital, University of California-Los Angeles, California 90095, USA. estiehm@mednet.ucla.edu
authors: E Richard
authors: ER
authors: Stiehm
authors: Robert L
authors: RL
authors: Roberts
authors: Michael S
authors: MS
authors: Kaplan
authors: Jonathan
authors: J
authors: Corren
authors: Eileen
authors: E
authors: Jaracz
authors: M Joyce
authors: MJ
authors: Rico
mesh_terms: D000907:Antibodies, Bacterial / Q000096:biosynthesis*; D000917:Antibody Formation / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D022242:Pneumococcal Vaccines / Q000276:immunology*; D013296:Streptococcus pneumoniae / Q000276:immunology*; D016559:Tacrolimus / Q000494:pharmacology* / Q000627:therapeutic use; D014611:Vaccination
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000907:Antibodies, Bacterial; D007166:Immunosuppressive Agents; D022242:Pneumococcal Vaccines; D016559:Tacrolimus