A clinical trial of intradermal and intramuscular seasonal influenza vaccination in patients with atopic dermatitis

Donald Y.M. Leung, Brett Jepson, Lisa A. Beck, Jon M. Hanifin, Lynda C. Schneider, Amy S. Paller, Katherine Monti, Gloria David, Jennifer Canniff, Margarita Gomez Lorenzo, Adriana Weinberg

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background Antibody responses to the inactivated seasonal influenza vaccine in patients with atopic dermatitis (AD) have not been carefully characterized. Objective The primary objective of this study was to compare antibody responses to intradermal vaccination in participants with moderate/severe AD with those in nonatopic participants. Secondary objectives were to evaluate the effect of route of administration, Staphylococcus aureus skin colonization, and disease severity on vaccine response. Methods This was an open-label study conducted in the 2012-2013 influenza season at 5 US clinical sites. A total of 360 participants with moderate/severe AD or nonatopic subjects were assessed for eligibility, 347 of whom received intradermal or intramuscular vaccination per label and were followed for 28 days after vaccination. The primary outcome was the difference in the proportion of participants achieving seroprotection (hemagglutination-inhibition antibody titer ≥1:40 on day 28 after vaccination). Results Seroprotection rates for influenza B, H1N1, and H3N2 were not different (1) between participants with AD and nonatopic participants receiving intradermal vaccination and (2) between AD participants receiving intradermal and intramuscular vaccination. After intradermal, but not intramuscular, vaccination, participants with AD with S aureus colonization experienced (1) lower seroprotection and seroconversion rates and lower hemagglutination-inhibition antibody titer geometric mean fold increase against influenza B and (2) lower seroconversion rates against influenza H1N1 than noncolonized participants with AD. Conclusion Participants with AD colonized with S aureus exhibited a reduced immune response to influenza vaccination compared with noncolonized participants after intradermal but not intramuscular vaccination. Because most patients with AD are colonized with S aureus, intramuscular influenza vaccination should be given preference in these patients.

Original languageEnglish (US)
Pages (from-to)1575-1582.e8
JournalJournal of Allergy and Clinical Immunology
Issue number5
StatePublished - May 2017


  • Atopic dermatitis
  • Staphylococcus aureus
  • antibody
  • eczema
  • influenza
  • skin
  • vaccination

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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