Do Vaccines Cause Asthma?

Conclusion | Epidemiological Evidence | Proposed Biological Mechanism | Archives | References


Conclusion

Natural infection with influenza can contribute to asthma exacerbation. Thus, influenza vaccine prevents asthma exacerbation by protecting against natural infection. Vaccines currently routinely recommended to the general population in the U.S.* do not cause asthma or asthma exacerbation. Live attenuated influenza vaccines used previously in the United States may have caused asthma exacerbation in young children, but were not recommended for that age group, and are now no longer recommended for any age group.

Epidemiological Evidence

The 2012 report by the Institute of Medicine (IOM) [1], now called the National Academy of Medicine (NAM), described a number of studies with sufficient validity and precision that all reported no association between inactivated influenza vaccination and asthma exacerbation [2-10]. The report described several studies with sufficient validity and precision that generally reported no association between live attenuated influenza vaccination (LAIV) and asthma exacerbation as well [11-17]. However, a 2015 white paper on the safety of influenza vaccines concluded that LAIV was associated with an increase in wheezing in young children with a history of wheezing [18].

Proposed Biological Mechanism

Influenza, along with other natural viral respiratory infections, can contribute to asthma exacerbation, as these viruses enter and replicate within airway epithelial cells, initiating an immune response. Natural influenza infection also causes greater morbidity in asthmatic subjects than in the general population, perhaps due to a difference in the antiviral response of asthmatics [19].

The 2012 IOM report described cases of asthma exacerbation after both inactivated and live attenuated influenza vaccination [20]; however, even after considering knowledge about the aforementioned natural infection, the IOM concluded that this mechanistic evidence was weak [1].

References

1. Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
2. The safety of inactivated influenza vaccine in adults and children with asthma. The New England journal of medicine 2001;345:1529-36.
3. Bueving HJ, Bernsen RM, de Jongste JC, et al. Does influenza vaccination exacerbate asthma in children? Vaccine 2004;23:91-6.
4. France EK, Glanz JM, Xu S, et al. Safety of the trivalent inactivated influenza vaccine among children: a population-based study. Archives of pediatrics & adolescent medicine 2004;158:1031-6.
5. Hambidge SJ, Glanz JM, France EK, et al. Safety of trivalent inactivated influenza vaccine in children 6 to 23 months old. Jama 2006;296:1990-7.
6. Kmiecik T, Arnoux S, Kobryn A, Gorski P. Influenza vaccination in adults with asthma: safety of an inactivated trivalent influenza vaccine. J Asthma 2007;44:817-22.
7. Nicholson KG, Nguyen-Van-Tam JS, Ahmed AH, et al. Randomised placebo-controlled crossover trial on effect of inactivated influenza vaccine on pulmonary function in asthma. Lancet 1998;351:326-31.
8. Pedroza A, Huerta JG, Garcia Mde L, et al. The safety and immunogenicity of influenza vaccine in children with asthma in Mexico. Int J Infect Dis 2009;13:469-75.
9. Stenius-Aarniala B, Huttunen JK, Pyhala R, et al. Lack of clinical exacerbations in adults with chronic asthma after immunization with killed influenza virus. Chest 1986;89:786-9.
10. Tata LJ, West J, Harrison T, Farrington P, Smith C, Hubbard R. Does influenza vaccination increase consultations, corticosteroid prescriptions, or exacerbations in subjects with asthma or chronic obstructive pulmonary disease? Thorax 2003;58:835-9.
11. Ashkenazi S, Vertruyen A, Aristegui J, et al. Superior relative efficacy of live attenuated influenza vaccine compared with inactivated influenza vaccine in young children with recurrent respiratory tract infections. The Pediatric infectious disease journal 2006;25:870-9.
12. Belshe RB, Edwards KM, Vesikari T, et al. Live attenuated versus inactivated influenza vaccine in infants and young children. The New England journal of medicine 2007;356:685-96.
13. Belshe RB, Nichol KL, Black SB, et al. Safety, efficacy, and effectiveness of live, attenuated, cold-adapted influenza vaccine in an indicated population aged 5-49 years. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2004;39:920-7.
14. Bergen R, Black S, Shinefield H, et al. Safety of cold-adapted live attenuated influenza vaccine in a large cohort of children and adolescents. The Pediatric infectious disease journal 2004;23:138-44.
15. Gaglani MJ, Piedra PA, Riggs M, Herschler G, Fewlass C, Glezen WP. Safety of the intranasal, trivalent, live attenuated influenza vaccine (LAIV) in children with intermittent wheezing in an open-label field trial. The Pediatric infectious disease journal 2008;27:444-52.
16. Piedra PA, Gaglani MJ, Riggs M, et al. Live attenuated influenza vaccine, trivalent, is safe in healthy children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a community-based, nonrandomized, open-label trial. Pediatrics 2005;116:e397-407.
17. Fleming DM, Crovari P, Wahn U, et al. Comparison of the efficacy and safety of live attenuated cold-adapted influenza vaccine, trivalent, with trivalent inactivated influenza virus vaccine in children and adolescents with asthma. The Pediatric infectious disease journal 2006;25:860-9.
18. Halsey NA, Talaat KR, Greenbaum A, et al. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2015;33 Suppl 5:F1-f67.
19. Jackson DJ, Johnston SL. The role of viruses in acute exacerbations of asthma. The Journal of allergy and clinical immunology 2010;125:1178-87; quiz 88-9.
20. de Jongste JC, Degenhart HJ, Neijens HJ, Duiverman EJ, Raatgeep HC, Kerrebijn KF. Bronchial responsiveness and leucocyte reactivity after influenza vaccine in asthmatic patients. Eur J Respir Dis 1984;65:196-200.