Transcutaneous yellow fever vaccination of subjects with or without atopic dermatitis

Abstract

Background Atopic dermatitis (AD) is a common inflammatory skin disease with global prevalence ranging from 3% to 20%. AD patients have an increased risk for complications following viral infection (e.g., herpes simplex virus), and vaccination of AD patients with live vaccinia virus is contraindicated due to a heightened risk of eczema vaccinatum, a rare but potentially lethal complication associated with smallpox vaccination. Objective To develop a better understanding of immunity to cutaneous viral infection in AD patients. Methods In a double-blind, randomized study, we investigated the safety and immunogenicity of live attenuated yellow fever virus (YFV) vaccination of non-atopic (NA) subjects and AD patients following standard subcutaneous (SC) inoculation or transcutaneous (TC) vaccination administered with a bifurcated needle. Viremia, neutralizing antibody, and antiviral T cell responses were analyzed for up to 30 days post-vaccination. Results YFV vaccination by either route was well tolerated. SC vaccination resulted in higher seroconversion rates than TC vaccination but elicited similar antiviral antibody levels and T cell responses in both NA and AD groups. Following TC vaccination, both groups mounted similar neutralizing antibody responses, but AD patients demonstrated lower antiviral T cell responses by 30 days after vaccination. Among TC-vaccinated subjects, a significant inverse correlation between baseline IgE levels and the magnitude of antiviral antibody and CD4+ T cell responses was observed. Conclusions YFV vaccination of AD patients by the TC route revealed that high baseline IgE levels provides a potential biomarker for predicting reduced virus-specific immune memory following TC infection with a live virus.

Asthma as a risk factor for zoster in adults: A population-based case-control study

“…15,18,19 Although there is limited information on adaptive immune functions in asthmatics, there is some evidence that patients with asthma or other atopic conditions may have impairment or incompetence in cell-mediated immunity. 19,21,58 …”

Patients with atopic dermatitis have attenuated and distinct contact hypersensitivity responses to common allergens in skin

“…Our findings have implications beyond allergic sensitization; decreased vaccination responses observed in patients with AD might be mechanistically linked to attenuated ACD responses by the increased regulatory tone observed in this study. 62 Although decreased ACD responses in patients with AD might be desirable, the decreased T H 1 component, if present in response to infectious antigens, might be undesirable for vaccinations or control of cutaneous infections. Strategies to boost T H 1 responses in AD skin might thus need to be considered to increase the effectiveness of clinically relevant immune responses.…”

IgE cross-linking impairs monocyte antiviral responses and inhibits influenza-driven TH1 differentiation

“…8 Similarly, patients with atopic dermatitis had decreased virus-specific T H 1 cells after transcutaneous live virus vaccination, which inversely correlated with serum IgE levels. 9 In future studies, it will be important to evaluate effects of IgE cross-linking on T-cell priming by monocytes exposed to other viruses, including rhinoviruses, and compare responses in atopic (high IgE) versus nonatopic individuals.…”