ORIGINAL ARTICLE

¹ Allergy Centre, Poznan, Poland
² Paediatric Pharmacology Research Unit, Royal Children’s Hospital, Parkville, Victoria, Australia
³ Division of Pneumonology and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
⁴ I Katedra Pediatrii Klinika Alergologii I Kardiologii, Wroclawska Akademia Medyczna, Wroclaw, Poland
⁵ Centrum Pulmonologii Dzieciecej, Karpacz, Poland
⁶ Department of Paediatrics, Women’s and Children’s Hospital, North Adelaide, Adelaide, Australia
⁷ Dermatology Department, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
⁸ Fremantle Dermatology Clinic, Fremantle, Western Australia, Australia
⁹ Hauptstr 240, Kehl, Germany
¹⁰ Oddzial Pulmonologii I Alergologii, Slaskie Centrum Pediatrii, Zabrze, Poland
¹¹ Hudlaeknastödin, Kopavogur, Iceland
¹² Department of Dermatology, Heim Pal Children’s Hospital, Budapest, Hungary

Correspondence to:
T Hofman
Allergy Centre, Boguslawskiego 16a, 60-214 Poznan, Poland; T.Hofman{at}interia.pl

Background: Concern exists that the prolonged application of immunomodulators to treat atopic dermatitis may cause systemic immunosuppression.

Aims: In a 7-month, multicentre, randomised, controlled trial, we investigated the equivalence of response to vaccination against meningococcal serogroup C disease with a protein-conjugate vaccine in children (2–11 years) with moderate to severe atopic dermatitis, by applying either 0.03% tacrolimus ointment (TAC-O; n = 21) or a hydrocortisone ointment regimen (HC-O; n = 111).

Methods: TAC-O was applied twice daily (bid) for 3 weeks, and thereafter daily until clearance. 1% hydrocortisone acetate (HA) for head/neck and 0.1% hydrocortisone butyrate ointment for trunk/limbs was applied bid for 2 weeks; thereafter HA was applied bid to all affected areas. At week 1, patients were vaccinated with protein-conjugate vaccine against meningococcal serogroup C, and challenged at month 6 with low dose meningococcal polysaccharide vaccine. The control group (44 non-atopic dermatatits children) received the primary vaccination and challenge dose. Assessments were made at baseline, weeks 1 and 5, and months 6 and 7. The primary end point was the percentage of patients with a serum bactericidal antibody (SBA) titre 8 at the week 5 visit.

Results: The response rate (patients with SBA titre 8) was 97.5% (confidence interval (CI) approximately 97.3 to 100), 99.1% (94.8 to 100) and 97.7% (93.3 to 100) in the TAC-O, HC-O and control groups, respectively.

Conclusions: The immune response to vaccination against meningococcal serogroup C in children with atopic dermatitis applying either 0.03% TAC-O or HC is equivalent. Ointment application does not affect the immediate response to vaccination, generation of immune memory or humoral and cell-mediated immunity.

Abbreviations: SAE, serious adverse event; SBA, serum bactericidal antibody; TAC-O, tacrolimus ointment

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