title: Literature-based immunization recommendations for patients requiring immunosuppressive medications for autoimmune bullous dermatoses.
abstract: Autoimmune bullous diseases, such as pemphigus, pemphigoid, and dermatitis herpetiformis, are uniquely associated with vulnerability in the mucocutaneous barrier against infection. The management of immunobullous diseases is complex and may at times require immunosuppressive medications. Iatrogenic immunosuppression may increase susceptibility to vaccine-preventable illnesses. Currently, there are no guidelines to assist the clinician treating patients with immunobullous disease regarding the delivery of various vaccinations. The aim of this review is to provide recommendations for immunization in the unique setting of immunobullous disease. Recommendations are based on careful review of the literature in other conditions requiring iatrogenic immunosuppression, as well as the most recent Centers for Disease Control and Prevention guidelines. Immunization with nonlive vaccines appears to be a safe and effective strategy for preventing infection in the particularly susceptible patient with immunobullous disease. Opportunities for live vaccine administration may become available at lower levels of immune suppression or during clinical remission when immunosuppressive regimens can be reduced. Anticipatory vaccination before the initiation of iatrogenic immunosuppression is ideal. Although immunologic response to vaccination may be suboptimal during immunosuppression, nonlive vaccination is strongly recommended for this patient population.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Laniosz
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, MN, USA.|Division of Dermatopathology and Cutaneous Immunopathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Lehman
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Poland
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Wetter
mesh_terms: D001327:Autoimmune Diseases / Q000188:drug therapy*; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D017325:Hepatitis B Vaccines; D053061:Herpes Zoster Vaccine; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007252:Influenza Vaccines; D053918:Papillomavirus Vaccines; D022242:Pneumococcal Vaccines; D017410:Practice Guidelines as Topic; D012872:Skin Diseases, Vesiculobullous / Q000188:drug therapy* / Q000276:immunology*; D014611:Vaccination; D014612:Vaccines; D015164:Vaccines, Inactivated
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D017325:Hepatitis B Vaccines; D053061:Herpes Zoster Vaccine; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D053918:Papillomavirus Vaccines; D022242:Pneumococcal Vaccines; D014612:Vaccines; D015164:Vaccines, Inactivated