Asthma Appears to Be a Risk Factor for Herpes Zoster

Summary and Comment |
February 18, 2016

Asthma Appears to Be a Risk Factor for Herpes Zoster

  1. Jeffrey P. Callen, MD

For patients with increased risk and immunocompromise, discuss the risks and benefits of vaccination.

  1. Jeffrey P. Callen, MD

Asthma is a common chronic pulmonary disease that is associated with atopic dermatitis and allergic rhinitis. It is said to affect 7% to 17% of the U.S. population. Herpes zoster (HZ) is a recurrence of the varicella zoster virus occurring more often in older adults. A vaccine to prevent HZ is approved for people older than 50, with a relative contraindication for people with compromised immune status.

Authors of this population-based, case-controlled study examined whether adult asthma patients have increased risk for HZ. They matched 317 HZ patients with 742 controls and found history of asthma in 23% (87) of HZ patients versus 15% (114) of controls (adjusted odds ratio, 1.70; P= 0.03). They also noted that history of HZ vaccination was equally common among cases and controls (83 vs. 196). They found no association with asthma activity or use of inhaled or systemic corticosteroids. They also noted a nonstatistically significant trend to greater risk in asthma patients with history of atopic dermatitis.

Comment

This report is interesting on a number of levels. Despite an intervention that lowers the risk for shingles, 22% of HZ patients had been vaccinated. The vaccine maker's website clearly states that it offers imperfect protection. Another issue raised by this study is the contraindication in patients with compromised immune status. Although I do not treat asthma, many of my adult patients with severe atopic dermatitis whom I have on immunosuppressive therapy have asthma. Patients who have seen benefit from immunosuppressive therapy do not wish to interrupt it for vaccination, and I do not wish to recommend vaccination during therapy because of the possibility of disseminated viral infection following vaccination and the possible lack of full vaccine effect.

Bottom line: The risks and potential benefits of vaccination should be carefully discussed with patients with asthma.

Editor Disclosures at Time of Publication

  • Disclosures for Jeffrey P. Callen, MD at time of publication Consultant / Advisory board XOMA; Eli Lilly; Celgene Equity Various trust accounts Editorial boards JAMA Dermatology; UpToDate Leadership positions in professional societies Association of Professors of Dermatology (President-Elect)

Citation(s):

Reader Comments (1)

Sheldon Ball, PhD,MD Physician, Geriatrics, Humana

This is my favorite part "They also noted that history of HZ vaccination was equally common among cases and controls"...

Dear Merck & Co. Inc,
Never let your product get in the way of advertising.

see http://www.anvita.info/wiki/Herpes_Zoster_Vaccine

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