A systematic review and expert Delphi Consensus recommendation on the use of vaccines in patients receiving dupilumab: A position paper of the American College of Allergy, Asthma and Immunology

Jay A. Lieberman, Department of Pediatrics, The University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee.
Derek K. Chu, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
Tasnuva Ahmed, Department of Health Research Methods, Evidence, and Impact, Evidence in Allergy Group, McMaster University, Hamilton, Canada.
Timothy E. Dribin, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Elissa M. Abrams, Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada.
Aikaterini Anagnostou, Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Kimberly G. Blumenthal, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Mark Boguniewicz, Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colorado.
Nicole M. Chase, Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
David B. Golden, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Nicholas L. Hartog, Department of Allergy and Immunology, Corewell Health Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Jennifer R. Heimall, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Tina Ho, Dermatology Section, Division of Immunology, Boston Children's Hospital and Harvard Medical school, Boston, Massachusetts.
Monica G. Lawrence, Departments of Medicine and Pediatrics, University of Virginia, Charlottesville, Virginia.
David A. Khan, Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Timothy Dean Minniear, Division of Pediatric Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee.
S Shahzad Mustafa, Rochester Regional HealthFollow
John J. Oppenheimer, Rutgers New Jersey Medical School, Newark, New Jersey.
Elizabeth J. Phillips, Center for Drug Safety and Immunology, Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Allison Ramsey, Rochester Regional HealthFollow
Nicholas L. Rider, Section of Allergy & Immunology, Department of Health Systems & Implementation Science, The Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Lynda Schneider, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
Marcus S. Shaker, Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Jonathan M. Spergel, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Cosby A. Stone, Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
David R. Stukus, Division of Allergy/Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
Julie Wang, Division of Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine, Mount Sinai, New York.
Matthew J. Greenhawt, Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.

Department

Allergy and Immunology

Document Type

Article

Publication Title

Annals of Allergy, Asthma & Immunology

Abstract

BACKGROUND: Dupilumab is a monoclonal antibody that targets the interleukin (IL)-4 receptor alpha subunit, thus blocking the effects of IL-4 and IL-13, and has shown efficacy in treating various conditions including asthma, atopic dermatitis, eosinophilic esophagitis, and others. Because of its immune modulatory effects, clinical trials that studied dupilumab did not allow patients to receive live vaccines during the clinical trials because of an abundance of caution, and thus package inserts recommend that patients who are being treated with dupilumab should avoid live vaccines. Because dupilumab is now approved for use in patients from 6 months of age for the treatment of atopic dermatitis, this reported contraindication is now posing a clinical dilemma for patients and clinicians.

OBJECTIVE: To perform a systematic review of literature on the safety and efficacy of vaccinations in patients who are receiving dupilumab and to provide expert guidance on the use of vaccines in patients who are receiving dupilumab.

METHODS: A systematic review of the literature was performed, and an expert Delphi Panel was assembled.

RESULTS: The available literature on patients who received vaccinations while using dupilumab overall suggests that live vaccines are safe and that the vaccine efficacy, in general, is not affected by dupilumab. The expert Delphi panel agreed that the use of vaccines in patients receiving dupilumab was likely safe and effective.

CONCLUSION: Vaccines (including live vaccines) can be administered to patients receiving dupilumab in a shared decision-making capacity.

First Page

286

Last Page

294

DOI

10.1016/j.anai.2024.05.014

Volume

133

Issue

3

Publication Date

9-1-2024

Medical Subject Headings

Humans; Antibodies, Monoclonal, Humanized (therapeutic use); Asthma (drug therapy); Consensus; Delphi Technique; Dermatitis, Atopic (drug therapy); Vaccination (adverse effects); Vaccines (adverse effects, therapeutic use)

PubMed ID

38848870

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