Steroid-induced secondary immune deficiency

Despite their widespread clinical use, oral corticosteroids (OCSs) are well known to be associated with a myriad of adverse effects, including immunosuppression. By inhibiting transcription factors and affecting leukocyte function, pro-longed OCS use leads to significant CD4 lymphopenia and often a decrease in serum immunoglobulin (Ig)G. Conversely, OCS use has minimal impact on circulating B cell, serum IgM, or serum IgA levels. Although there is a paucity of litera-ture, individuals treated with prolonged OCS seem to typically maintain humoral response to various vaccinations despite hypogammaglobinemia, but this area warrants additional research, especially in the setting of the coronavirus disease 2019 pandemic. Individuals treated with prolonged OCS use are most at risk for opportunistic infections, espe-cially those with underlying malignancy and history of bone marrow transplant. Risk mitigation strategies to decrease infectious complication with OCS use include limiting the dose and duration of therapy, appropriately completing a full vaccination series, consideration for passive immunization, and prophylaxis against opportunistic infections.& COPY; 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Automated summary

Despite being widely used in clinical settings, oral corticosteroids (OCSs) are known to have numerous adverse effects, including immunosuppression. Prolonged use of OCS leads to significant reduction in CD4 lymphocyte count and serum immunoglobulin (Ig)G levels. However, the impact on B cells, IgM, and IgA levels is minimal. Further research is needed to understand the humoral response to vaccinations in individuals treated with prolonged OCS use, especially during the COVID-19 pandemic. Strategies to mitigate the risk of opportunistic infections in individuals treated with prolonged OCS include limiting dose and duration, completing full vaccination series, considering passive immunization, and prophylaxis against opportunistic infections.