Q: My son takes inhaled corticosteroid medication daily for his asthma. Is it safe to give him childhood vaccines such as those for chickenpox, measles or influenza?
David Bernstein, MD: Yes, these vaccines are absolutely safe for children on inhaled corticosteroids. First let’s explain how vaccines work: When administered, live vaccines such as measles or mumps expose you to a small dose of a weakened form of the live virus, allowing your body to build immunity without risk of infection to that virus.
Corticosteroid medications are known to suppress the immune system. However, the medication dose for inhaled corticosteroids is very small – less than 2 milligrams – so there is no possibility this dose would suppress the immune system and increase the risk of an infection after vaccination. There’s no impact on the effectiveness of the vaccine, either.
However, if your son stops taking his daily asthma medication – whether for a vaccination or anything else – then he may be at risk for an asthma flare.
Regarding the influenza vaccine, the U.S. Centers for Disease Control and Prevention recommends everyone ages 6 months and older receive the flu vaccination, especially people at high risk for complications such as those with asthma.
Vaccinations remain the most effective tool we have to prevent infectious diseases. With the recent reemergence of illnesses such as measles and pertussis (whooping cough), it’s important to stay vigilant with your child’s vaccinations.
Q: What about oral corticosteroids?
A: Children on oral systemic corticosteroids rarely have complications from vaccinations. However, long-term (two weeks or longer) or large doses (20 milligrams or more per day) of oral systemic corticosteroids can suppress immunity and the vaccine may put patients at an increased risk for an infection, including the illness the
vaccine was supposed to prevent.
If your child is on oral systemic corticosteroids, speak with a board-certified allergist or your primary care doctor about whether your child should receive these vaccinations.
David Bernstein, MD, FACAAI, is a board-certified allergist and immunologist with the Bernstein Allergy Group, Inc., in Cincinnati. He is a past Board of Regents member with the American College of Allergy, Asthma & Immunology (ACAAI).
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