Vaccination in immunocompromised children

2016 ◽  
Author(s):  
Marloes Heijstek ◽  
Mario Abinun ◽  
Nico Wulffraat
Keyword(s):  
Disease Activity ◽  
Immunosuppressive Treatment ◽  
Immunosuppressive Drugs ◽  
High Dose ◽  
Necrosis Factor Alpha ◽  
Live Attenuated Vaccines ◽  
European League Against Rheumatism ◽  
Increased Risk ◽  
Immunosuppressed Patients ◽  
Factor Alpha

Can immunocompromised children be safely and effectively vaccinated? This chapter discusses the recommendations from the European League Against Rheumatism (EULAR) for the immunization of immunocompromised patients. Patients with rheumatic or autoinflammatory diseases treated with high-dose glucocorticoids, high-dose disease-modifying antirheumatic drugs (DMARDs), or biologicals are considered immunocompromised. Safe and effective vaccination is crucial in these patients, given their increased risk of infection. Safe vaccination implies that vaccination has no effect on disease activity and has only mild adverse effects. Effective vaccination denotes that patients are protected against infections after immunization. Particularly in severely immunosuppressed patients, concerns arise on the safety of (live-attenuated) vaccines and on the detrimental effect of immunosuppressive treatment on the immunogenicity of vaccines. Overall, vaccinations do not increase disease activity and do not cause severe adverse events. It is recommended to withhold live-attenuated vaccines in patients on high-dose immunosuppressive drugs and biologicals, but booster vaccinations can be considered when essential. Generally, immunogenicity of vaccines is good with some exceptions: responses are reduced in patients on high-dose glucocorticoids and rituximab; methotrexate reduces responses to (pneumococcal) polysaccharide vaccines; and tumour necrosis factor alpha (TNFα‎) may lower vaccine-induced antibody concentrations and may cause accelerated waning of immunity. Offering vaccination before immunosuppressive drugs and/or measuring antibodies after immunization is recommended.

Vaccination in immunocompromised children

2013 ◽  
pp. 721-724
Author(s):  
Marloes Heijstek ◽  
Mario Abinun ◽  
Nico Wulffraat
Keyword(s):  
Disease Activity ◽  
Immunosuppressive Treatment ◽  
Immunosuppressive Drugs ◽  
High Dose ◽  
Necrosis Factor Alpha ◽  
Live Attenuated Vaccines ◽  
European League Against Rheumatism ◽  
Increased Risk ◽  
Immunosuppressed Patients ◽  
Factor Alpha

Can immunocompromised children be safely and effectively vaccinated? This chapter discusses the recommendations from the European League Against Rheumatism (EULAR) for the immunization of immunocompromised patients. Patients with rheumatic or autoinflammatory diseases treated with high-dose glucocorticoids, high-dose disease-modifying antirheumatic drugs (DMARDs), or biologicals are considered immunocompromised. Safe and effective vaccination is crucial in these patients, given their increased risk of infection. Safe vaccination implies that vaccination has no effect on disease activity and has only mild adverse effects. Effective vaccination denotes that patients are protected against infections after immunization. Particularly in severely immunosuppressed patients, concerns arise on the safety of (live-attenuated) vaccines and on the detrimental effect of immunosuppressive treatment on the immunogenicity of vaccines. Overall, vaccinations do not increase disease activity and do not cause severe adverse events. It is recommended to withhold live-attenuated vaccines in patients on high-dose immunosuppressive drugs and biologicals, but booster vaccinations can be considered when essential. Generally, immunogenicity of vaccines is good with some exceptions: responses are reduced in patients on high-dose glucocorticoids and rituximab; methotrexate reduces responses to (pneumococcal) polysaccharide vaccines; and tumour necrosis factor alpha (TNFα‎‎) may lower vaccine-induced antibody concentrations and may cause accelerated waning of immunity. Offering vaccination before immunosuppressive drugs and/or measuring antibodies after immunization is recommended.

Vaccination in immunocompromised children

2013 ◽  
Author(s):  
Marloes Heijstek ◽  
Mario Abinun ◽  
Nico Wulffraat
Keyword(s):  
Disease Activity ◽  
Immunosuppressive Treatment ◽  
Immunosuppressive Drugs ◽  
High Dose ◽  
Necrosis Factor Alpha ◽  
Live Vaccines ◽  
Live Attenuated Vaccines ◽  
European League Against Rheumatism ◽  
Increased Risk ◽  
Immunosuppressed Patients

Can immunocompromised children be safely and effectively vaccinated? This chapter discusses the recommendations from the European League Against Rheumatism (EULAR) for the immunization of immunocompromised patients. Patients with rheumatic or autoinflammatory diseases treated with high-dose glucocorticoids, high-dose disease-modifying anti-rheumatic drugs (DMARDs), or biologicals are considered immunocompromised. Safe and effective vaccination is crucial in these patients, given their increased risk of infection. Safe vaccination implies that vaccination has no effect on disease activity and has only mild adverse effects. Effective vaccination denotes that patients are protected against infections after immunization. Particularly in severely immunosuppressed patients, concerns arise on the safety of (live-attenuated) vaccines and on the detrimental effect of immunosuppressive treatment on the immunogenicity of vaccines. Overall, vaccinations do not increase disease activity and do not cause severe adverse events. Although non-live vaccines are safe, it is recommended to withhold live-attenuated vaccines in patients on high-dose immunosuppressive drugs and biologicals. However, booster vaccinations can be considered when essential. Generally, immunogenicity of vaccines is good with some exceptions: responses are reduced in patients on high-dose glucocorticoids and rituximab; methotrexate reduces responses to (pneumococcal) polysaccharide vaccines; and anti-tumour necrosis factor alpha (TNFα‎) may lower vaccine-induced antibody concentrations. Offering vaccination before immunosuppressive drugs and/or measuring antibodies after immunization is recommended.

High-Producer Haplotypes of Tumor Necrosis Factor Alpha and Lymphotoxin Alpha Are Associated With an Increased Risk of Myeloma and Have an Improved Progression-Free Survival After Treatment

2000 ◽  
Vol 18 (15) ◽  
pp. 2843-2851 ◽  
Author(s):  
Faith E. Davies ◽  
Sara J. Rollinson ◽  
Andrew C. Rawstron ◽  
Eve Roman ◽  
Stephen Richards ◽  
...  
Keyword(s):  
Overall Survival ◽  
Progression Free Survival ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Necrosis Factor Alpha ◽  
Free Survival ◽  
Increased Risk ◽  
Factor Alpha ◽  
Lymphotoxin Alpha ◽  
Necrosis Factor

PURPOSE: To determine the effect of polymorphic variations in the tumor necrosis factor alpha (TNFα) and lymphotoxin alpha (LTα) genes on the predisposition to myeloma and the effect of these polymorphisms on response to treatment and overall survival. PATIENTS AND METHODS: Genotype distribution was determined in 63 patients with monoclonal gammopathy of uncertain significance (MGUS) and 198 patients with myeloma and compared with that in 250 age- and sex-matched population-based controls. The effect on treatment response and survival was determined in 171 myeloma patients treated with either conventional or high-dose chemotherapy. RESULTS: Comparison of the extended TNFα/LTα haplotype in the myeloma cases and controls showed a significant excess of high-producer alleles in the cases. The double heterozygotes TNF1/2 and LT10.5/5.5 were present in 35.8% of cases but in only 18% of the controls; this presence was associated with a significant increased risk of myeloma (odds ratio, 2.05; 95% confidence interval, 1.26 to 3.35). A similar odds ratio was seen in the MGUS cases, suggesting that this genotype is associated with the initiation of plasma-cell disorders rather than the progression of MGUS to myeloma. The median overall survival time of myeloma patients was 53.8 months and showed no difference with regard to TNFα/LTα polymorphic status. A trend toward an improved progression-free survival was apparent in cases with a high-producer haplotype, although this effect was seen only in patients receiving high-dose chemotherapy. CONCLUSION: Individuals with polymorphisms associated with a high production of TNFα/LTα are at a significantly increased risk of developing MGUS and myeloma. The impact of polymorphic status on overall survival is minimal, although there is a trend toward an increased progression-free survival in the high-producer group.

scholarly journals Possible Protective Effect of Diacerein on Doxorubicin-Induced Nephrotoxicity in Rats

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Marwa M. M. Refaie ◽  
Entesar F. Amin ◽  
Nashwa F. El-Tahawy ◽  
Aly M. Abdelrahman
Keyword(s):  
Protective Effect ◽  
Low Dose ◽  
Caspase 3 ◽  
Interleukin 1 ◽  
Treated Group ◽  
Limiting Factors ◽  
High Dose ◽  
Necrosis Factor Alpha ◽  
Factor Alpha ◽  
Necrosis Factor

Nephrotoxicity is one of the limiting factors for using doxorubicin (DOX). Interleukin 1 has major role in DOX-induced nephrotoxicity, so we investigated the effect of interleukin 1 receptor antagonist diacerein (DIA) on DOX-induced nephrotoxicity. DIA (25 and 50 mg/kg/day) was administered orally to rats for 15 days, in the presence or absence of nephrotoxicity induced by a single intraperitoneal injection of DOX (15 mg/kg) at the 11th day. We measured levels of serum urea, creatinine, renal reduced glutathione (GSH), malondialdehyde (MDA), total nitrites (NOx), catalase, and superoxide dismutase (SOD). In addition, caspase-3, tumor necrosis factor alpha (TNFα), nuclear factor kappa B (NFκB) expressions, and renal histopathology were assessed. Our results showed that DOX-induced nephrotoxicity was ameliorated or reduced by both doses of DIA, but diacerein high dose (DHD) showed more improvement than diacerein low dose (DLD). This protective effect was manifested by significant improvement in all measured parameters compared to DOX treated group by using DHD. DLD showed significant improvement of creatinine, MDA, NOx, GSH, histopathology, and immunohistochemical parameters compared to DOX treated group.

Malignancy

2013 ◽  
pp. 172-176
Author(s):  
Jennifer Hamilton ◽  
Clive Kelly
Keyword(s):  
Rheumatic Disease ◽  
Evidence Base ◽  
Necrosis Factor Alpha ◽  
Relative Risks ◽  
Underlying Malignancy ◽  
Clinical Presentations ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
Musculoskeletal Manifestations ◽  
Factor Alpha

This chapter addresses the links between malignancy and rheumatic disease. It begins with a summary of rheumatological conditions associated with an increased risk of malignancy, and describes and discusses specific neoplasms associated with each rheumatic disorder. The present knowledge base is summarized in tabular form, describing the relative risks of different malignancies for each relevant rheumatic disease. The diseases featured include rheumatoid arthritis, primary Sjögren’s syndrome, scleroderma, dermatomyositis and systemic lupus. The next section reviews the drugs used in present rheumatological practice known to be associated with malignancy, describing the specific established risks linked to each of the following agents: azathioprine, cyclophosphamide, ciclosporin, anti-tumour necrosis factor alpha (TNFα‎‎) agents, and mycophenolate mofetil. The evidence base and strength of these associations are summarized. Finally we describe the musculoskeletal manifestations that arise as a consequence of underlying malignancy, considering bone pain, polymyalgia, arthropathy, and vasculitis as clinical presentations or complications of underlying neoplasia. This section also includes descriptions of less common rheumatic disorders that may also be associated with cancer, including erythema nodosum, Sweet’s syndrome, and pyoderma gangrenosum.

Effects of psoriasis treatment on genital warts: a case report

2019 ◽  
Vol 30 (8) ◽  
pp. 828-830 ◽  
Author(s):  
Marco Campoli ◽  
Elisa Cinotti ◽  
Michele Fimiani ◽  
Michele Pellegrino ◽  
Linda Tognetti ◽  
...  
Keyword(s):  
Cytotoxic T Lymphocyte ◽  
Clinical Manifestations ◽  
Genital Warts ◽  
Immunosuppressive Drugs ◽  
Additional Treatment ◽  
Cell Mediated Immunity ◽  
Complete Regression ◽  
Necrosis Factor Alpha ◽  
Tnf Α ◽  
Factor Alpha

The use of immunosuppressive drugs predisposes to infections, as they block the most important stage in antiviral defense, which is the cytotoxic T-lymphocyte HLA-dependent response. We report a case of extensive genital warts in a young woman on therapy for psoriasis with cyclosporine, afterwards successfully treated with an anti-tumor necrosis factor alpha (TNF-α) agent. Cyclosporine may predispose to the reactivation of latent infections and may favor the clinical manifestations of human papillomavirus (HPV)-related diseases, due to the inhibition of cell-mediated immunity that plays a crucial role in controlling HPV infections. In the literature the relationship between HPV and TNF-blockers has not yet been clearly defined. Our case underlines that the prompt interruption of cyclosporine can induce a complete regression of warts without any additional treatment and adds evidence to the possible use of anti-TNF-α in patients with psoriasis and genital warts.

scholarly journals The Polymorphism −308G/A ofTumor Necrosis Factor-αGene Modulates the Effect of Immunosuppressive Treatment in First Kidney Transplant Subjects Who Suffer an Acute Rejection

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ana Isabel Sánchez-Fructuoso ◽  
Isabel Pérez-Flores ◽  
Rosalia Valero ◽  
Maria Angeles Moreno ◽  
Miguel Fernandez-Arquero ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Acute Rejection ◽  
Immunosuppressive Treatment ◽  
Necrosis Factor Alpha ◽  
Transplant Outcome ◽  
Kidney Recipients ◽  
Tnf Α ◽  
Factor Alpha ◽  
Adjusted Logistic Regression ◽  
Necrosis Factor

The −308G/A SNP oftumor necrosis factor-alpha (TNF-α) geneaffects TNF-αproduction. As its impact on transplant outcome remains open to debate, we decided to genotype it in a cohort of transplant subjects. A retrospective analysis of 439 first kidney recipients randomly divided into two subgroups (discovery and validation cohorts) was performed to identify the best predictors of acute rejection (AR). The effect on transplant outcome was analyzed by an adjusted logistic regression model. Carriers of the A allele, associated with elevated TNF-αproduction, presented a higher risk of AR (OR = 2.78; 95% CI = 1.40–5.51). Logistic regression analyses for AR showed an interaction between the polymorphism and treatment with thymoglobulin (p-interaction = 0.03). In recipients who did not receive thymoglobulin, carriers of A allele had higher risk of AR (OR = 4.05; 95% CI = 1.76–9.28). Moreover, carriers of A allele not treated with thymoglobulin presented higher risk of AR than those who received thymoglobulin (OR = 13.74; 95% CI = 1.59–118.7). The AUC of the model in the discovery cohort was 0.70 and in the validation cohort was 0.69. Our findings indicate that the −308G/ATNF-αpolymorphism is associated with AR risk and it modulates the effectiveness of thymoglobulin treatment. This pharmacogenetic effect lets us propose this SNP as a useful predictor biomarker to tailor immunosuppressive regimens.

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