Immunotherapy and Guillain-Barre syndrome
Question:
1/26/2018
I am seeing an 8 1/2 year old girl with environmental allergies who is interested in immunotherapy. She had a history of Guillain-Barre syndrome at age 3. She has not had any additional issues and was discharged from Neurology at age 4. She has had her IPV and MMR without any issues. Is having a history of Guillain-Barre a contraindication to starting immunotherapy?
Answer:
Vaccinations, particularly to influenza, have been associated with Guillian Barre (1,2,3) although other vaccines have not been associated (4). Allergy immunotherapy is a type of vaccination which stimulates a Th1 response and suppresses a Th2 response. There is a theoretical concern but the experience of over a 100 years of allergen immunotherapy is very reassuring. There options for allergy care other than immunotherapy but there are great advantages of allergen immunotherapy. The decision would require documentation of some form of shared decision making but I do not think a history of Guillian Barre would make allergen immunotherapy contraindicated. Guillian Barre may be an autoimmune disorder triggered by vaccination or infection. The immunotherapy practice guidelines include the following statement, which I believe applies to this question.
"Although concern about the safety of allergen immunotherapy in patients with autoimmune disorders has been raised in the past, there is no substantive evidence that such treatment is harmful in patients with these diseases. Therefore the benefits and risks of allergen immunotherapy in patients with HIV infection, other immunodeficiencies, or autoimmune disorders must be assessed on an individual basis."
1.Veitia, Jesyree, et al. "Guillian-Barre Syndrome (GBS) in Children after Influenza Vaccination, An analysis of the Vaccine Adverse Event Reporting System (VAERS) Database, 1991–2015 (S30. 003)." (2017): S30-003.
2.Ghaderi, Sara, et al. "Risk of Guillain-Barré syndrome after exposure to pandemic influenza A (H1N1) pdm09 vaccination or infection: a Norwegian population-based cohort study." European journal of epidemiology 31.1 (2016): 67-72.
3. Vellozzi, Claudia, Shahed Iqbal, and Karen Broder. "Guillain-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence." Clinical infectious diseases 58.8 (2014): 1149-1155.
4. Gee, Julianne, et al. "Risk of Guillain-Barré Syndrome following quadrivalent human papillomavirus vaccine in the Vaccine Safety Datalink." Vaccine 35.43 (2017): 5756-5758.
I hope this information is of help to you and your patient.
All my best.
Dennis K. Ledford, MD, FAAAAI