Are People With Asthma More Likely to Suffer Flu Vaccine Side Effects?

Can the Flu Vaccine Cause Asthma Exacerbations?

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You've probably heard that the flu shot is recommended if you have asthma, but are people with asthma more likely to experience flu vaccine side effects? What do you need to know?

Asthma and Flu Vaccines

In general, people with asthma should get the flu vaccine unless there is a reason not to, such as a history of a Guillain Barre syndrome in the past. For many years there was a fear that people with egg allergies should not get the flu shot, but that doesn't usually appear to be the case.

(Talk to your doctor if this is the case.)

So why do so many people with asthma (roughly half) skip their annual flu shots? One reason is the concern that the flu shot could cause a worsening of asthma, so we will address that here. Another is that people may not think they are at risk. Given the statistics, however, there is a good chance of winning the "flu lottery." Each year in the United States there are between 9.2 and 35.6 million cases of influenza, 140,000 to 710,000 hospitalizations, and 12,000 to 56,000 deaths.

Some people are afraid to get the flu shot if a family member is immunosuppressed or on chemotherapy. This is not a problem, however, with the injectable flu shot (the live attenuated flu vaccine, such as Flumist or Fluenz should be avoided.) Conversely, failing to get a flu shot can put your loved ones at risk and vice versa.

So we're left with two questions. How bad is it if you catch the flu when you have asthma, and are people with asthma more likely to have side effects from the vaccine?

Asthma and Influenza

People with asthma are no more likely to get the flu than people without asthma, but they are more likely to experience complications. Influenza can work both to trigger asthma symptoms in the first place, and to worsen asthma symptoms you are already dealing with. Catching the flu when you have asthma also raises your risk of pneumonia, especially if you are a child or older adult.

Influenza is clearly more dangerous if you have asthma, but is the vaccine more of a problem as well?

Are Asthma Exacerbations One of the Flu Vaccine Side Effects?

We have known that the inactivated flu vaccine (one of the flu shots) does not increase asthma exacerbations in the two weeks following vaccination. At one time it was thought that the live attenuated nasal spray vaccine (Flumist or Fluenz) might be associated with wheezing, and the package insert warns against giving the vaccine to young children with asthma or anyone with recent episodes of wheezing. More recent studies, however, seem to suggest that neither the flu shot or Flumist increase the risk of asthma exacerbations.

In a 2017 study following almost 400,000 flu immunizations given to children age 2 and older, the risk of asthma exacerbation was not increased for children who received either the inactivated influence vaccine or the live attenuated influenza vaccine.

Another 2017 study evaluating a population base of 6.3 million people came to a similar conclusion. It was found that while the live attenuated flu vaccine was used less than one percent of the time, and primarily for those with mild persistent asthma or intermittent asthma, it did not appear to increase the risk of asthma exacerbations.

Based on this study, there was no increase in any type of respiratory adverse events for those receiving the live vaccine.

Despite these studies, some physicians recommend that children and adults with asthma receive the flu shot vaccine rather than the nasal spray vaccine. The shot (specifically, Flu-Zone High dose or the traditional flu shot rather than the intradermal shot) appears to be more effective than the nasal spray for those with serious medical conditions or the elderly.

Is Getting the Flu One of the Flu Vaccine Side Effects?

While some people with asthma will report mild symptoms such as sore throat, cough, and hoarseness after getting a flu vaccination, the virus in the inactivated vaccine is killed so it can't give anyone the flu.

In contrast, the nasal spray flu vaccine is a live (though attenuated) virus. Even with the live, weakened form of the virus in Flumist, the virus is scientifically unable to cause the flu.

Minor Flu Vaccine Side Effects

Just as with all medical treatments there are potential side effects to the flu vaccine. Some of the minor flu vaccine side effects include:

  • Pain at the injection site
  • Fever
  • Malaise (just feeling poorly overall)
  • Myalgias (muscle aches)
  • Headache

Generally, these side effects occur within several hours to a few days after the vaccine and will resolve on their own.

Major Flu Vaccine Side Effects and Asthma

Anaphylaxis (a serious allergic reaction) is a rare, but life threatening reaction that may occur after receiving a flu vaccination. While it occurs in only 1 out of 1,000,000 vaccinations, you will need to see an allergist if this occurs or if you develop any worsening of your asthma after getting vaccinated. Since anaphylaxis in response to the flu shot is very uncommon, we aren't certain whether it is more common in people with asthma.

If you have any symptoms of anaphylaxis, such shortness of breath, swelling of your mouth, tongue, or neck, wheezing, lightheadedness, or a feeling of impending doom, seek medical attention immediately.

Summary of Flu Vaccine Side Effects in People With Asthma

The flu vaccine is recommended for everyone with asthma who does not have a contraindication. Contracting the flu can be dangerous for people with asthma, increasing the risk of pneumonia, hospitalization, or even death.

The flu vaccine, in contrast, does not appear to be any more dangerous for people with asthma than those without the condition, though some physicians recommend getting the flu shot rather than the nasal spray vaccine. Making sure family and friends of a person with asthma are vaccinated is helpful as well.

Influenza causes far too many episodes of illness, hospitalization, and even death, but these risks can be reduced by making sure you and your loved ones get the annual flu shot.

Sources:

Centers for Disease Control and Prevention. Disease Burden of Influenza. Updated 05/16/17. https://www.cdc.gov/flu/about/disease/burden.htm

Centers for Disease Control and Prevention. Key Facts About Seasonal Flu Vaccine. Updated 10/06/17. https://www.cdc.gov/flu/protect/keyfacts.htm

Duffy, J., Lewis, M., Harrington, T. et al. Live Attenuated Influenza Vaccine Use and Safety in Children and Adults with Asthma. Annals of Allergy Asthma and Immunology. 2017. 118(4):439-444.

Ray, G., Lewis, N., Goddard, K. et al. Asthma Exacerbations Among Asthmatic Children Receiving Live Attenuated Versus Inactivated Influenza Vaccines. Vaccine. 2017. 35(20):2668-2675.

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