A new position paper by the American College of Allergy, Asthma & Immunology (ACAAI) explores the safety of administering live vaccines to patients undergoing treatment with dupilumab. This biologic therapy is used for various allergic conditions. The paper, titled "The Use of Vaccines in Patients Receiving Dupilumab: A Systematic Review and Expert Delphi Consensus Recommendation: A Position Paper of the American College of Allergy, Asthma & Immunology," has been published online in Annals of Allergy, Asthma & Immunology.
The review panel concluded that it is not necessary to stop dupilumab treatment when administering live vaccines. However, they emphasize the importance of shared decision-making between physicians and patients or their parents regarding risks and benefits.
The study aimed to identify a method allowing patients benefiting from dupilumab to also receive full vaccine protection as recommended by health agencies. Dupilumab treats conditions such as asthma, atopic dermatitis, chronic rhinosinusitis, and eosinophilic esophagitis in children.
A Delphi panel composed of allergy and immunology experts conducted the systematic review. Interest in this issue increased after dupilumab was approved for children as young as six months old. Live vaccines on the U.S. schedule include measles, mumps, rubella (MMR), varicella, rotavirus, and nasal spray influenza vaccine.
Since its approval for adults in 2017 and children in 2020, manufacturers advised against concurrent administration of live vaccines with dupilumab due to concerns about its immunomodulatory effects potentially reducing vaccine effectiveness or increasing infection risk. However, the panel found limited data not supporting these concerns but acknowledged that a large study is needed for definitive safety evidence.
Panel recommendations stress shared decision-making regarding live vaccine administration during dupilumab treatment or pausing treatment if necessary. Board-certified allergists/immunologists are specially trained to manage such cases.
Lead author Jay Lieberman, MD, FACAAI, along with other contributors to the paper were thanked by ACAAI.
ACAAI represents over 6,000 allergists-immunologists and allied health professionals based in Arlington Heights, Illinois. The organization promotes collaboration among its members towards patient care improvement through education and research initiatives.
