Influenza immunization

Question

Dear team members,
My daughter , 6 years old , was diagnosed with CF when 9 months old, she had positive culture for Aspergillus fumigtaus from tracheal secretion(2 positives results, IgE 750 , Aspergillus-specific Ig E 3,25, normal thoracic Rx image, without any clinical signs of infection just loss of appetite). She was treated for 4 months with voriconazole and prednisone (starting with 30 mg) . Now, the prednisone dose is 5 mg per day and one day pause (alternative). The treatment result was good ( decrease of Ig E levels, but not to normal values yet), she does not cough , appetite increased; sometimes she has problems with sleep (I think that this is the prednisone effect). I would like to ask you what do you recommend in continuation, considering that we stopped, following his doctor’s advice, the voriconazole (after 4 months), but still take the prednisone. Also I would like to ask if the gripal immunization is recommended, if she takes 5 mg prednisone .
Thank you for your attention.

Answer

"Dear questioner,

Your daughter has been diagnosed with Allergic Broncho-Pulmonary Aspergillosis,
an allergic reaction to the fungus Aspergillus fumigatus, which occurs in around
2% of CF patients. However, the diagnosis is not always easy to make and to
ensure the diagnosis, several criteria should be fulfilled, such as the
apperance of clinical symptoms (mainly cough, wheeze, exercise intolerance,
decline in pulmonary function, increased sputum production), IgE levels >500
U/ml, a positive skin test to Aspergillus, specific antibodies to Aspergillus in
the serum or abnormalities in the chest radiography. So there is no one single
test which makes it difficult to find the diagnosis.

If the diagnosis is made, the treatment consists mainly of the administration
of cortisone beginning with a high dose, than decreasing the dose. Additional
antifungal treatment (e.g. with voriconazole in the case of your daughter) has
been shown to be beneficial with the effect of being able to reduce the
cortisone dose and to finish cortisone therapy earlier.

The decision, when a certain therapy (voriconazole or cortisone) can be
stopped, can unfortunately not given by us via the internet, but has always to
be considered by your CF doctor in charge. The reason for this is that the
judgment of the efficacy of the treatment is dependent on many factors and can
only be made if all aspects of the illness have been taken into account from a
person having all information about your specific case, which is your CF doctor
in charge.

Regarding the influenza (flu) immunization:

Cortisone is a drug which has a suppressive influence on the immune system. As
the vaccination against influenza is based on inactivated virus, in other words:
no living and proliferating germs are injected, there is no increased risk of
giving such a vaccine under cortisone therapy. However it could be that the
success of the vaccination (producing antibodies against influenza) will be
decreased because of a cortisone therapy as the immune system is suppressed. The actual cortisone therapy of your daughter is however quite low dose, so that the suppression would probably not influence the success of the vaccination.
Therefore, if the influenza period is beginning soon, one would recommend this
vaccination to your daughter in spite of the 5mg prednisolone in case the
doctors in charge decide to go on with that.

If you have any question please do not hesitate to ask.

Thank you for your attention,

Prof.Ioan Popa"

08.01.2009