Eczema Could Compromise Flu Shots


Researchers suggest that patients with eczema should request that their flu shots be administered intramuscularly and not intradermally.

If you have eczema, your annual flu shot will probably be a little bit more effective if you are willing to put a little more pain into the process of getting it. According to Donald Leung, PhD, an allergist and immunologist at National Jewish Health’s Department of Pediatrics, patients with eczema should request that their flu shots be administered in their muscle in order to optimize their chances of avoiding the seasonal infection.

Dr. Leung blamed Staphylococcus skin infections, which are common in eczema patients, for diminished flu vaccine efficacy, noting, “Up to 90% of patients with severe disease [are] colonized by the bacteria.” Staph appears to interfere with the immune response the flu vaccine is intended to elicit that ultimately bolsters the patient’s immune system against the disease.

Eczema, also called atopic dermatitis, is a chronic skin condition that makes the skin red and itchy. Although it is particularly common in children, it can occur at any age. According to the Centers for Disease Control and Prevention (CDC), about one in 10 children aged 0 to 17 years has “eczema or some form of skin allergy, and about seven in every 100 adults (18 years and older) have chronic eczema.” Because eczema can be exacerbated by a patient’s exposure to allergens such as foods or environmental factors, these individuals are particularly susceptible to staph infections and, furthermore, their immune systems may not be as effective in defending against staph or flu as a result of the long-term battle against the dermatitis.

Dr. Leung and his team evaluated immune responses to the flu shot in 202 people with eczema and 136 people without the skin condition. Half of the participants received an intradermal (below the skin) flu vaccine injection, while the other half received an intramuscular injection. Only about 11% of those individuals in the intradermal group developed protection against the flu after a month, while nearly half (47%) of the intramuscular group had. A total of 42% of the participants who had eczema also had staph skin infections.

Although Dr. Leung and his team stopped short of conclusively linking the bacterial infection and the lower flu immunization rate among patients who received that intradermal injection, they did say that prior studies indicate that staph can cause immune cells to “retreat” from the skin and become less active in general. The group emphasized that their results “highlight the need for special care when immunizing people with eczema.”

According to Nick Francis, PhD, a clinical reader at Cardiff University and co-author on a recently published study indicating that children with mild eczema may not benefit from antibiotic treatments, the resistance to various medical “norms,” such as flu shots, for patients with eczema likely extends far beyond requesting a shot in the muscle.

“It has been estimated that 40% of children with eczema aged five years or younger are given antibiotics in the course of a year,” Dr. Francis said, adding that he and his team “question the ongoing use of antibiotics for eczema flares” based on their recent research. The team conducted a 3-arm, blinded, randomized, controlled trial in United Kingdom ambulatory care units to evaluate whether or not children who received antibiotic treatment for mild eczema flares benefitted from the treatment. “Neither oral nor topical antibiotics produced a significant difference in mean Patient Oriented Eczema Measure (POEM) scores,” reported the group, adding, “We ruled out a clinically meaningful benefit from the addition of either oral or topical antibiotics.”

The CDC notes, “Drug allergies and intolerances are more common in people with immune deficiencies largely because they are exposed to more drugs.” However, in the case of chronic eczema sufferers and flu shots, the issue appears to revolve around the staph infection’s “dampening” of the vaccine’s efficacy.

The stakes are particularly high in the case of eczema patients with staph, though, because staph infections come with an additional flu-related complication: higher morbidity if a patient does eventually catch the flu. As early as 2008, researchers linked pediatric flu deaths and pediatric staph infections, with physicians blaming bacterial pneumonia, seizures, and shock, in part, or all, upon the staph infection entering the bloodstream during the flu infection.

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