Infectious complications with the use of biologic response modifiers in infants and children

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Biologic response modifi ers (BRMs) are substances that interact with and modify the host immune system. BRMs that dampen the immune system are used to treat conditions such as juvenile idiopathic arthritis, psoriatic arthritis, or infl ammatory bowel disease and often in combination with other immunosuppressive agents, such as methotrexate and corticosteroids. Cytokines that are targeted include tumor necrosis factor α; interleukins (ILs) 6, 12, and 23; and the receptors for IL-1α (IL-1A) and IL-1β (IL-1B) as well as other molecules. Although the risk varies with the class of BRM, patients receiving immune-dampening BRMs generally are at increased risk of infection or reactivation with mycobacterial infections (Mycobacterium tuberculosis and nontuberculous mycobacteria), some viral (herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, hepatitis B) and fungal (histoplasmosis, coccidioidomycosis) infections, as well as other opportunistic infections. The use of BRMs warrants careful determination of infectious risk on the basis of history (including exposure, residence, and travel and immunization history) and selected baseline screening test results. Routine immunizations should be given at least 2 weeks (inactivated or subunit vaccines) or 4 weeks (live vaccines) before initiation of BRMs whenever feasible, and inactivated infl uenza vaccine should be given annually. Inactivated and subunit vaccines should be given when needed while taking BRMs, but live vaccines should be avoided unless under special circumstances in consultation with an infectious diseases specialist. If the patient develops a febrile or serious respiratory illness during BRM therapy, consideration should be given to stopping the BRM while actively searching for and treating possible infectious causes.

Original languageEnglish (US)
Article numbere20161209
JournalPediatrics
Volume138
Issue number2
DOIs
StatePublished - Aug 1 2016

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Inactivated Vaccines
Subunit Vaccines
Vaccines
Interleukins
Immune System
Immunization
Infection
History
Coccidioidomycosis
Interleukin-23
Nontuberculous Mycobacteria
Histoplasmosis
Psoriatic Arthritis
Human Herpesvirus 3
Interleukin-1 Receptors
Juvenile Arthritis
Opportunistic Infections
Simplexvirus
Interleukin-12
Immunosuppressive Agents

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Infectious complications with the use of biologic response modifiers in infants and children. / Davies, Herbert Dele.

In: Pediatrics, Vol. 138, No. 2, e20161209, 01.08.2016.

Research output: Contribution to journalArticle

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