Transcutaneous yellow fever vaccination of subjects with or without atopic dermatitis

• Published in: Journal of allergy and clinical immunology 2014-02, Vol.133 (2), p.439-447
• Main Authors: Slifka, Mark K., PhD, Leung, Donald Y.M., MD, PhD, Hammarlund, Erika, MS, Raué, Hans-Peter, PhD, Simpson, Eric L., MD, MCR, Tofte, Susan, FNP, Baig-Lewis, Shahana, MPH, David, Gloria, PhD, Lynn, Henry, PhD, Woolson, Rob, MS, JD, Hata, Tissa, MD, Milgrom, Henry, MD, Hanifin, Jon, MD
• Format: Article
• Language: English
• Subjects: Administration, Cutaneous; Adult; Allergic diseases; Allergy and Immunology; Antibodies, Viral - blood; antibody; Arboviroses; atopic dermatitis; Biological and medical sciences; Cells, Cultured; Clinical trials; Cytokines; Dermatitis, Atopic - blood; Dermatitis, Atopic - immunology; Dermatitis, Atopic - virology; Disease; Double-Blind Method; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Herpes simplex virus; Human viral diseases; Humans; IgE; Immunoglobulin E - blood; Immunopathology; Infectious diseases; Leukocytes, Mononuclear; Male; Medical sciences; Pain; Pregnancy; RNA, Viral - analysis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Skin allergic diseases. Stinging insect allergies; Smallpox; Studies; T-cell memory; T-Lymphocytes - immunology; Tropical viral diseases; Vaccination; Vaccines; Vaccinia virus; Viral diseases; Viral infections; Viremia; Yellow fever; Yellow Fever - prevention & control; Yellow Fever Vaccine - administration & dosage; Yellow Fever Vaccine - adverse effects; Yellow fever virus
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2013.10.037

Background Atopic dermatitis (AD) is a common inflammatory skin disease with a global prevalence ranging from 3% to 20%. Patients with AD have an increased risk for complications after viral infection (eg, herpes simplex virus), and vaccination of patients with AD with live vaccinia virus is contraindicated because of a heightened risk of eczema vaccinatum, a rare but potentially lethal complication associated with smallpox vaccination. Objective We sought to develop a better understanding of immunity to cutaneous viral infection in patients with AD. Methods In a double-blind randomized study we investigated the safety and immunogenicity of live attenuated yellow fever virus (YFV) vaccination of nonatopic subjects and patients with AD after standard subcutaneous inoculation or transcutaneous vaccination administered with a bifurcated needle. Viremia, neutralizing antibody, and antiviral T-cell responses were analyzed for up to 30 days after vaccination. Results YFV vaccination administered through either route was well tolerated. Subcutaneous vaccination resulted in higher seroconversion rates than transcutaneous vaccination but elicited similar antiviral antibody levels and T-cell responses in both the nonatopic and AD groups. After transcutaneous vaccination, both groups mounted similar neutralizing antibody responses, but patients with AD demonstrated lower antiviral T-cell responses by 30 days after vaccination. Among transcutaneously vaccinated subjects, a significant inverse correlation between baseline IgE levels and the magnitude of antiviral antibody and CD4+ T-cell responses was observed. Conclusions YFV vaccination of patients with AD through the transcutaneous route revealed that high baseline IgE levels provide a potential biomarker for predicting reduced virus-specific immune memory after transcutaneous infection with a live virus.