Pneumococcal seroconversion after vaccination for children with atopic dermatitis treated with tacrolimus ointment

Area of Science:

• Immunology
• Dermatology
• Pediatrics

Background:

• Atopic dermatitis (AD) is a chronic inflammatory skin condition.
• Concerns exist regarding the impact of topical immunosuppressants on vaccine response.
• Tacrolimus is a topical calcineurin inhibitor used for AD treatment.

Purpose of the Study:

• To evaluate the effect of topical tacrolimus on B- and T-cell immunity.
• To assess the primary antibody response to pneumococcal polysaccharide vaccine in children with AD treated with tacrolimus.

Main Methods:

• Open-label, noncomparative study of 23 children (2-12 years) with moderate to severe AD.
• Treatment with tacrolimus 0.03% ointment twice daily for 7 weeks.
• Immunization with 23-valent pneumococcal polysaccharide vaccine after 3 weeks; antibody response measured pre- and post-vaccination.

Main Results:

• No significant changes in complete blood count, lymphocyte subsets, or immunoglobulin levels.
• Tacrolimus blood levels remained low (<1 ng/mL).
• Significant increase in protective pneumococcal titers post-vaccination (70% vs 9% pre-vaccination); 91% showed a >4-fold titer increase for at least 4 serotypes.

Conclusions:

• Topical tacrolimus ointment does not impair the serologic response to pneumococcal vaccination.
• Tacrolimus treatment does not interfere with existing T- and B-cell immune responses in children with atopic dermatitis.