[CIS-PAGID] ALPS Patient Question

[Fleisher, Thomas (NIH/CC/DLM) [E]]

Joe,
I just confirmed with our clinical people that our rather extensive experience with ALPS patients does not suggest that vaccination is typically involved with disease exacerbation. We have not seen a flare in ITP with influenza immunizations and do encourage our ALPS patients to receive this vaccine.  There was a comment regarding one patient who had a flare that from a time line perspective may have been associated with pneumococcal vaccine but owing to the risk of serious pneumococcal disease in the setting of splenectomy (we have a fair number of referred ALPS patients who have have a history of a splenectomy) we also recommend this vaccine. Clearly, whether or not Tdap has a potential to be associated with a flare is not something that I think can be accurately predicted and obviously with growing concerns about pertussis one would really have to consider the risk of not vaccinating.
Tom

Thomas A. Fleisher, M.D.
Chief, Department of Laboratory Medicine
NIH Clinical Center
tel 301 496-5668
fax 301 402-1612
email tfleishe at mail.nih.gov<mailto:tfleishe at mail.nih.gov>


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________________________________
From: Church, Joseph [mailto:JChurch at chla.usc.edu]
Sent: Tuesday, March 08, 2011 11:30 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] ALPS Patient Question

Colleagues:

A 16yo boy with Fas mutation-confirmed ALPS developed prolonged thrombocytopenia following his "flu" shot last year.

He is due to receive Tdap in the near future, and I am concerned about re-activating his platelet problem.

Has anyone had a similar issue?  Should I give steroids at the time of Tdap?  Other thoughts?

Thanks.

Joe Church
Children's Hospital Los Angeles





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