title: A clinical trial of intradermal and intramuscular seasonal influenza vaccination in patients with atopic dermatitis.
abstract: BACKGROUND
  Antibody responses to the inactivated seasonal influenza vaccine in patients with atopic dermatitis (AD) have not been carefully characterized.
  
  
  OBJECTIVE
  The primary objective of this study was to compare antibody responses to intradermal vaccination in participants with moderate/severe AD with those in nonatopic participants. Secondary objectives were to evaluate the effect of route of administration, Staphylococcus aureus skin colonization, and disease severity on vaccine response.
  
  
  METHODS
  This was an open-label study conducted in the 2012-2013 influenza season at 5 US clinical sites. A total of 360 participants with moderate/severe AD or nonatopic subjects were assessed for eligibility, 347 of whom received intradermal or intramuscular vaccination per label and were followed for 28 days after vaccination. The primary outcome was the difference in the proportion of participants achieving seroprotection (hemagglutination-inhibition antibody titer ≥1:40 on day 28 after vaccination).
  
  
  RESULTS
  Seroprotection rates for influenza B, H1N1, and H3N2 were not different (1) between participants with AD and nonatopic participants receiving intradermal vaccination and (2) between AD participants receiving intradermal and intramuscular vaccination. After intradermal, but not intramuscular, vaccination, participants with AD with S aureus colonization experienced (1) lower seroprotection and seroconversion rates and lower hemagglutination-inhibition antibody titer geometric mean fold increase against influenza B and (2) lower seroconversion rates against influenza H1N1 than noncolonized participants with AD.
  
  
  CONCLUSIONS
  Participants with AD colonized with S aureus exhibited a reduced immune response to influenza vaccination compared with noncolonized participants after intradermal but not intramuscular vaccination. Because most patients with AD are colonized with S aureus, intramuscular influenza vaccination should be given preference in these patients.
authors.affiliation: Department of Pediatrics, National Jewish Health, Denver, Colo. Electronic address: leungd@njhealth.org.
authors.forename: Donald Y M
authors.initials: DYM
authors.lastname: Leung
authors.affiliation: Rho, Chapel Hill, NC.
authors.forename: Brett
authors.initials: B
authors.lastname: Jepson
authors.affiliation: Department of Dermatology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Beck
authors.affiliation: Oregon Health & Science University, Portland, Ore.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Hanifin
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass.
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Schneider
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.affiliation: Rho, Chapel Hill, NC.
authors.forename: Katherine
authors.initials: K
authors.lastname: Monti
authors.affiliation: Rho, Chapel Hill, NC.
authors.forename: Gloria
authors.initials: G
authors.lastname: David
authors.affiliation: University of Colorado Denver, Aurora, Colo.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Canniff
authors.affiliation: National Institute of Allergy and Infectious Diseases, Rockville, Md.
authors.forename: Margarita Gomez
authors.initials: MG
authors.lastname: Lorenzo
authors.affiliation: University of Colorado Denver, Aurora, Colo.
authors.forename: Adriana
authors.initials: A
authors.lastname: Weinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D003876:Dermatitis, Atopic / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000097:blood / Q000276:immunology; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D000069078:Seroconversion; D012867:Skin / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007136:Immunoglobulins; D007252:Influenza Vaccines
keywords: Atopic dermatitis; Staphylococcus aureus; antibody; eczema; influenza; skin; vaccination