Steroid-induced secondary immune deficiency

Department

Allergy and Immunology

Document Type

Article

Publication Title

Annals of Allergy, Asthma & Immunology

Abstract

Despite their widespread clinical use, oral corticosteroids (OCSs) are well known to be associated with a myriad of adverse effects, including immunosuppression. By inhibiting transcription factors and affecting leukocyte function, prolonged OCS use leads to significant CD4 lymphopenia and often a decrease in serum immunoglobulin (Ig)G. Conversely, OCS use has minimal impact on circulating B cell, serum IgM, or serum IgA levels. Although there is a paucity of literature, individuals treated with prolonged OCS seem to typically maintain humoral response to various vaccinations despite hypogammaglobinemia, but this area warrants additional research, especially in the setting of the coronavirus disease 2019 pandemic. Individuals treated with prolonged OCS use are most at risk for opportunistic infections, especially those with underlying malignancy and history of bone marrow transplant. Risk mitigation strategies to decrease infectious complication with OCS use include limiting the dose and duration of therapy, appropriately completing a full vaccination series, consideration for passive immunization, and prophylaxis against opportunistic infections.

First Page

713

Last Page

717

DOI

10.1016/j.anai.2023.01.010

Volume

130

Issue

6

Publication Date

6-1-2023

Medical Subject Headings

Humans; COVID-19; Steroids; Adrenal Cortex Hormones (therapeutic use); Bone Marrow Transplantation; Opportunistic Infections (prevention & control, drug therapy)

PubMed ID

36681272

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