LESSWRONG
is fundraising!
LW
$

by Sameerishere
3 min read
A
14

13

Anyone have insight on (1) Whether there is a way to test how effective an immune response you had to the vaccine or (2) the extent to which inhaled glucocorticoids (specifically Symbicort) impact the effectiveness of the mRNA COVID vaccines (specifically Pfizer)? 

On (1) there doesn't seem to be any useful test commercially available.

  • This 3/29/21 article from MD Anderson says:
    • "The Centers for Disease Control and Prevention (CDC) discourages antibody testing for assessing immunity after getting the vaccine. A vaccinated person is very likely to get a negative result from a serology test, even if the vaccine was successful and protective. That’s because different serology tests detect antibodies to different parts of the virus. Some tests detect antibodies to the spike protein of the virus, which are produced in response to viral infection or the vaccine."
    • (It's unclear why they / the CDC then refrain from suggesting that people use those latter tests.)
  • This April 2021 article from Cleveland.com (citing an expert at Cleveland Clinic) says:
    • "There are tests that can provide some information about someone’s immune response to the vaccine, but those tests are conducted by labs and are not available for anyone to buy, said Dr. James Fernandez, an allergy and immunology expert at the Cleveland Clinic.The lab tests can detect the level of Immunoglobulin G (IgG), the most common type of antibody that protects against infection, in someone’s blood. The problem is that experts don’t know what level of IgG is needed to constitute a “protective level,” Fernandez said.“We can’t faithfully or accurately or actively say what that means to you, [whether] you’re protected or not protected,” Fernandez said. “It’s just a number.”"
  • Apparently there are solutions to this under development, but not commercially available (or even past peer review):

On (2): It seems inhaled corticosteroids should be fine:

The AAAAI emphatically says: "No, there is no impact on an individual’s ability to respond to the vaccine and control of asthma is essential! There is no data to suggest that inhaled corticosteroids and/or leukotriene receptor antagonists impact on immunogenicity of the mRNA COVID-19 vaccines." 

(They seem to avoid the error of assuming that no evidence = no impact: they use different language when discussing another question on which "no information could be found and more information is needed" suggesting that they are not simply saying, "oh there are no studies on this so it's not a problem." They also seem to be speaking pretty specifically about Symbicort in that answer, since later they say "Daily oral steroids may interfere with the antibody response to the vaccine based on data with other immunosuppressives and flu vaccine.") (https://education.aaaai.org/resources-for-a-i-clinicians/vaccines-qa_COVID-19) 

Drugs.com somewhat confusingly says otherwise...

However, drugs.com says there are moderate interactions between Symbicort and the Pfizer COVID vaccine: "If you are currently being treated or have recently been treated with budesonide, you should let your doctor know before receiving SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine. Depending on the dose and length of time you have been on budesonide, you may have a reduced response to the vaccine. In some situations, your doctor may want to delay vaccination to give your body time to recover from the effects of budesonide therapy. If you have recently been vaccinated with SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine, your doctor may choose to postpone treatment with budesonide for a couple of weeks or more

"... For SARS-CoV-2 (COVID-19) vaccines, vaccination should preferably be completed at least two weeks before initiation of immunosuppressive therapies; however, decisions to delay immunosuppressive therapy to complete COVID-19 vaccination should consider the individual's risks related to their underlying condition. Vaccines may generally be administered to patients receiving corticosteroids as replacement therapy (e.g., for Addison's disease)." 

(https://www.drugs.com/interactions-check.php?drug_list=432-2530,4221-19642)

...but there's good reason to believe Symbicort is still fine:

  • A physician friend remarked: There's a big difference between the dosage of inhaled steroid received like Symbicort (micrograms) and oral steroids (milligrams). Budesonide comes in multiple formulations and can be inhaled or oral. I would not consider patients taking inhaled corticosteroids as immunocompromised or immunosuppressed."
  • MichaelLowe's comments below support this (and suggest a potential reason why drugs.com may have reached this conclusion in error).
     
Covid-19
Personal Blog

13

Is there a way to test your personal COVID vaccine response? How do corticosteroids impact response?
New Answer
New Comment

1 Answers sorted by
top scoring

MichaelLowe

20

2) There are some real concerns regarding systemic corticosteroid effects, but they mostly apply when getting shots and (I think) tablets. Inhaled budesonide has a much shorter half life and reduced bio availability, so there is much less reason for concern. 

[-]Sameerishere10

Thanks!  Would you be willing to give a little context on how you reached your conclusion?

Symbicort is solely a inhaled drug, as far as I can tell, so I believe the drugs.com reference would apply to that, unfortunately. 

Reply
2MichaelLowe
Sure; there is plenty of research on kids with asthma taking vaccines, e.g. here "Varicella vaccine failure in children was not associated with asthma or the use of inhaled steroids, but with the use of oral steroids" .  For the same opinion as guideline, see here.   I believe the drugs.com reference is automatically generated; their database lookup (presumably!) works this way: "brand name"-> "name of substance"->  "interactions of this substance with another substance (in this case the vaccine)". I.e. they do not make a disambiguation between form of administration. 
2Sameerishere
Appreciate it! Oddly, the "Professional" version of the drugs.com page on Symbicort does mention inhaled corticosteroids: "MONITOR: The administration of inactivated, killed, or otherwise noninfectious vaccines to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than 10 mg/day or 1 mg/kg/day of prednisone or equivalent for more than 2 weeks), or long-term topical or inhaled corticosteroids." That said, a physician friend of mine responded to my similar post on FB by saying the following, so combined with the research you cite, I'm inclined to think that I'm fine: "There's a big difference between the dosage of inhaled steroid received like Symbicort (micrograms) and oral steroids (milligrams). Budesonide comes in multiple formulations and can be inhaled or oral. I would not consider patients taking inhaled corticosteroids as immunocompromised or immunosuppressed." Further, the CDC reference cited by drugs.com says the following, bolstering the argument that Symbicort shouldn't be a problem. (Though it references live-virus vaccine. It's unclear how drugs.com got to its conclusion... perhaps it uses the programmatic approach you suggested.) "Corticosteroid therapy usually is not a contraindication to administering live-virus vaccine when administration is 1) short term (i.e., <14 days); 2) a low to moderate dose (i.e., <20 mg of prednisone or equivalent per day or <2mg/kg body weight per day for a young child); 3) long-term, alternate-day treatment with short-acting preparations; 4) maintenance physiologic doses (replacement therapy); or 5) topical (skin or eyes), inhaled, or by intra-articula
Moderation Log
A
10