Effect of antipyretic analgesics on immune responses to vaccination

Abstract

While antipyretic analgesics are widely used to ameliorate vaccine adverse reactions, their use has been associated with blunted vaccine immune responses. Our objective was to review literature evaluating the effect of antipyretic analgesics on vaccine immune responses and to highlight potential underlying mechanisms. Observational studies reporting on antipyretic use around the time of immunization concluded that their use did not affect antibody responses. Only few randomized clinical trials demonstrated blunted antibody response of unknown clinical significance. This effect has only been noted following primary vaccination with novel antigens and disappears following booster immunization. The mechanism by which antipyretic analgesics reduce antibody response remains unclear and not fully explained by COX enzyme inhibition. Recent work has focused on the involvement of nuclear and subcellular signaling pathways. More detailed immunological investigations and a systems biology approach are needed to precisely define the impact and mechanism of antipyretic effects on vaccine immune responses.

Effect of A Sun Protection Intervention on the Immune Response to Measles Booster Vaccination in Infants in Rural South Africa

“…Also, we did not record the type of medication, so were unable to determine whether this was a type of medication that could have altered immune responses to vaccination. Use of paracetamol, for example, after vaccination can reduce the response to primary vaccination and subsequently influence antibody levels after the booster vaccination . Breastfeeding at the time of the first measles vaccination, a well‐recognized determinant of the immune response to measles vaccination , was 62% in the control and 91% in the intervention groups (excluding the respondents who did not know, these values were 79% and 98% in the control and intervention groups, respectively).…”

“…Use of paracetamol, for example, after vaccination can reduce the response to primary vaccination and subsequently influence antibody levels after the booster vaccination . Breastfeeding at the time of the first measles vaccination, a well‐recognized determinant of the immune response to measles vaccination , was 62% in the control and 91% in the intervention groups (excluding the respondents who did not know, these values were 79% and 98% in the control and intervention groups, respectively). Transplacental transfer of maternal antibodies against measles results in increased antibody concentrations in infants .…”

The Use of Analgesics during Vaccination with a Live Attenuated Yersinia pestis Vaccine Alters the Resulting Immune Response in Mice

“…The administration of antipyretic analgesics is now a routine practice for patients receiving vaccinations and is recommended to ameliorate local and systemic side effects like fever and pain [1,2].…”

“…Analgesics such as acetaminophen, meloxicam, or ibuprofen are used as preventive strategies to reduce vaccine-related reactogenicity initiated at the time of vaccine administration and/or post-vaccination [2]. Adverse vaccination reactions such as localized swelling, rash, pain, and systemic reactions of fever, muscle pain, vomiting or diarrhea, and in severe cases central nervous system effects may entice some patients to use analgesics with or without medical directives in conjunction with vaccinations.…”

“…Whaley and Sloane demonstrated that anti-inflammatory drugs can inhibit the complement system without altering the antibody binding [6]. Antipyretic analgesics may impact the adaptive immune response at the cellular level affecting the entire process through antibody production [2]. The existing human data are somewhat contradictory and may be skewed depending upon the type of vaccination employed in the trials.…”