Q:

5/14/2014
I have a 9 y/o patient whose allergies are getting worse. I think he may benefit form immunotherapy. The mother has a question of its effects on his auto immune disease: vitiligo. I searched PubMed and found no articles. Is there any older literature that talks about immunotherapy and vitiligo. Will the allergy shots make the vitiligo worse?

A:

Thank you for your inquiry.

I am not aware of nor could I find in the literature any indication that the presence of vitiligo is a documented contraindication to the administration of allergen immunotherapy. I suppose that the worry is based upon the consideration that vitiligo can be an "autoimmune" disease and further stimulation of the immune system by immunizations of any sort could theoretically exacerbate this condition. We have dealt with this theoretical issue previously on a number of occasions on our website. You can pull up our responses to this question related to several diseases thought to be "autoimmune" in origin by clicking here and typing "contraindications to immunotherapy" into the search box. For your convenience, I have copied below a representative sample of our response to this theoretical issue in regards to the prototype of autoimmune conditions, systemic lupus erythematosus.

In summary, in my personal opinion, vitiligo would not be a contraindication to immunotherapy based upon any evidence in the literature, but the hypothesis that autoimmune disease in general could be a theoretical problem has not been dealt with definitively, and ultimately therefore, as noted in our response to the question on systemic lupus erythematosus, the decision to initiate immunotherapy in these conditions is left up to the physician and patient involved. I would personally, however, not withhold immunotherapy, in a patient with vitiligo.

Thank you again for your inquiry and we hope this response is helpful to you.

Is systemic lupus erythematosus a contraindication to immunotherapy?
Question:
In a patient with allergies, who also has SLE can we administer immunotherapt injections? Is there a role for immunotherapy in patients with autoimmune conditions and allergy?

Answer:
This question has been posed to our website on a number of occasions. The postings listed below deal with this question in reasonable detail. They are a little too lengthy to copy here for you, but you can access these entries by going to the Academy's "Ask the Expert" website and entering "immunotherapy" in the search box.

In summary, there is no definite contraindication to immunotherapy in a patient with SLE noted in the most recent immunotherapy parameter (1). Some physicians feel that there is a theoretical contraindication to immunizing patients with systemic lupus erythematosus because they do not wish to stimulate the immune system. However, this is theoretical and different opinions are rendered by different allergists. Therefore, the final decision as to whether to proceed with immunotherapy in a patient with lupus is left to the clinical judgment of the physician caring for the patient. As noted, a more detailed discussion of this issue can be found in the previous entries cited above.

Thank you again for your inquiry and we hope this response is helpful to you.

Reference:
1. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter, third update. Journal of Allergy and Clinical Immunology, September 2011; Volume 127 (1), Supplement, page S1-S55.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology