2) There are some real concerns regarding systemic corticosteroid effects, but they mostly apply when getting shots and (I think) tablets. Inhaled budesonide has a much shorter half life and reduced bio availability, so there is much less reason for concern.
I believe the drugs.com reference is automatically generated; their database lookup (presumably!) works this way: “brand name”-> “name of substance”-> “interactions of this substance with another substance (in this case the vaccine)”. I.e. they do not make a disambiguation between form of administration.
“MONITOR: The administration of inactivated, killed, or otherwise noninfectious vaccines to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than 10 mg/day or 1 mg/kg/day of prednisone or equivalent for more than 2 weeks), or long-term topical or inhaled corticosteroids.”
That said, a physician friend of mine responded to my similar post on FB by saying the following, so combined with the research you cite, I’m inclined to think that I’m fine: “There’s a big difference between the dosage of inhaled steroid received like Symbicort (micrograms) and oral steroids (milligrams). Budesonide comes in multiple formulations and can be inhaled or oral. I would not consider patients taking inhaled corticosteroids as immunocompromised or immunosuppressed.”
Further, the CDC reference cited by drugs.com says the following, bolstering the argument that Symbicort shouldn’t be a problem. (Though it references live-virus vaccine. It’s unclear how drugs.com got to its conclusion… perhaps it uses the programmatic approach you suggested.)
“Corticosteroid therapy usually is not a contraindication to administering live-virus vaccine when administration is 1) short term (i.e., <14 days); 2) a low to moderate dose (i.e., <20 mg of prednisone or equivalent per day or <2mg/kg body weight per day for a young child); 3) long-term, alternate-day treatment with short-acting preparations; 4) maintenance physiologic doses (replacement therapy); or 5) topical (skin or eyes), inhaled, or by intra-articular, bursal, or tendon injection (37). No evidence of an increased risk for more severe reactions to live, attenuated viral vaccines has been reported among persons receiving corticosteroid therapy by aerosol, and such therapy is not a reason to delay vaccination.” (Drugs.com also cites a CDC reference specific to COVID-19 vaccines, but it does not go into much relevant detail, and it links to the more general reference above.)
So tl;dr, I guess drugs.com is being imprecise here (perhaps for the reasons you mention), and the use of low-dose inhaled steroids should be ok!
2) There are some real concerns regarding systemic corticosteroid effects, but they mostly apply when getting shots and (I think) tablets. Inhaled budesonide has a much shorter half life and reduced bio availability, so there is much less reason for concern.
Thanks! Would you be willing to give a little context on how you reached your conclusion?
Symbicort is solely a inhaled drug, as far as I can tell, so I believe the drugs.com reference would apply to that, unfortunately.
Sure; there is plenty of research on kids with asthma taking vaccines, e.g. here
“Varicella vaccine failure in children was not associated with asthma or the use of inhaled steroids, but with the use of oral steroids” .
For the same opinion as guideline, see here.
I believe the drugs.com reference is automatically generated; their database lookup (presumably!) works this way: “brand name”-> “name of substance”-> “interactions of this substance with another substance (in this case the vaccine)”. I.e. they do not make a disambiguation between form of administration.
Appreciate it! Oddly, the “Professional” version of the drugs.com page on Symbicort does mention inhaled corticosteroids:
“MONITOR: The administration of inactivated, killed, or otherwise noninfectious vaccines to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than 10 mg/day or 1 mg/kg/day of prednisone or equivalent for more than 2 weeks), or long-term topical or inhaled corticosteroids.”
That said, a physician friend of mine responded to my similar post on FB by saying the following, so combined with the research you cite, I’m inclined to think that I’m fine: “There’s a big difference between the dosage of inhaled steroid received like Symbicort (micrograms) and oral steroids (milligrams). Budesonide comes in multiple formulations and can be inhaled or oral. I would not consider patients taking inhaled corticosteroids as immunocompromised or immunosuppressed.”
Further, the CDC reference cited by drugs.com says the following, bolstering the argument that Symbicort shouldn’t be a problem. (Though it references live-virus vaccine. It’s unclear how drugs.com got to its conclusion… perhaps it uses the programmatic approach you suggested.)
“Corticosteroid therapy usually is not a contraindication to administering live-virus vaccine when administration is 1) short term (i.e., <14 days); 2) a low to moderate dose (i.e., <20 mg of prednisone or equivalent per day or <2mg/kg body weight per day for a young child); 3) long-term, alternate-day treatment with short-acting preparations; 4) maintenance physiologic doses (replacement therapy); or 5) topical (skin or eyes), inhaled, or by intra-articular, bursal, or tendon injection (37). No evidence of an increased risk for more severe reactions to live, attenuated viral vaccines has been reported among persons receiving corticosteroid therapy by aerosol, and such therapy is not a reason to delay vaccination.” (Drugs.com also cites a CDC reference specific to COVID-19 vaccines, but it does not go into much relevant detail, and it links to the more general reference above.)
So tl;dr, I guess drugs.com is being imprecise here (perhaps for the reasons you mention), and the use of low-dose inhaled steroids should be ok!