If you haven’t had at least one debate with someone over the Covid-19 vaccine then you most likely have been living under a rock for the last year. The amount of misinformation circulating about the virus, the vaccine, or the nation’s response is mind boggling. My mission with this blog is to provide reliable information to families to help their children thrive. With that said, I have gotten lots of questions from my eczema families on whether they should consider the Covid-19 vaccine and if the vaccine will affect their eczema. Here is what you need to know.
The 3 Vaccine Options
We need to start with a brief review on vaccines and how they work. A vaccine forces your immune system to create antibodies and memory cells against a specific disease, usually with a dead or weakened form of the germ. The first, and possibly most famous, vaccine was created in 1796 when Dr Edward Jenner of Gloucestershire, England discovered he could protect patients from the dreaded smallpox virus by inoculating them with cowpox virus. In fact, the origin of the term “vaccine” is due to Jenner’s referring to the latin word for cow, “vacca”.
In an ironic twist, a history of eczema was an absolute contraindication to the smallpox vaccine due to the risk of developing Eczema Vaccinatum, a severe and sometimes fatal skin condition seen after the vaccination.
Our more modern vaccines, such as the yearly flu shot, have typically been made from a weakened form of the virus or even a “dead” or inactive form of the virus. Once administered, our body’s immune fighting system goes to work, creating antibodies and memory cells to a portion of the virus it deems key to invasion. Then, when our bodies encounter the real deal, it has a prebuilt army waiting to fight the battle against the virus.
One of the reasons many Americans and even scientists have been apprehensive about the Covid-19 vaccine, is that new technology was utilized to create these vaccines, and they are all a bit different. One basic premise all 3 available vaccines share, is they all are created to attack what’s called the spike protein of Covid-19. The spike proteins (seen in red below) are what the virus uses to attach and enter our cells.
Pfizer and Moderna Vaccines
The vaccines developed by Pfizer and Moderna are very similar so we will discuss those together. These vaccines use a new technology called mRNA coding. Unlike vaccines that put a weakened or inactivated disease germ into the body, the Pfizer and Moderna mRNA vaccines deliver a tiny piece of genetic code from the Covid virus to host cells in the body, essentially giving those cells instructions, or blueprints, for making copies of spike proteins. Our bodies then mount an immune response to those spike proteins (that ironically it just made itself). The resulting antibodies and memory cells should then give long term immunity from the virus.
Johnson and Johnson (Janssen) Vaccine
This is a carrier vaccine, which uses a different approach than the mRNA vaccines to instruct human cells to make the Covid spike protein. Scientists engineer a harmless adenovirus (a common virus that, when not inactivated, can cause colds, bronchitis, and other illnesses) as a shell to carry genetic code on the spike proteins to the cells (similar to a Trojan Horse). The shell and the code can’t make you sick, but once the code is inside the cells, the cells produce a spike protein to train the body’s immune system, which creates antibodies and memory cells to protect against an actual Covid infection.
None of the vaccines contain eggs, gelatin, latex, or preservatives. All COVID-19 vaccines are free from metals such as iron, nickel, cobalt, lithium, rare earth alloys or any manufactured products such as microelectronics, electrodes, carbon nanotubes, or nanowire semiconductors.
Both the Pfizer-BioNTech and Moderna COVID-19 vaccines contain polyethylene glycol (PEG). PEG is a primary ingredient in laxatives and oral bowel preparations for colonoscopy procedures, an inactive ingredient or excipient in many medications, and is used in a process called “pegylation” to improve the therapeutic activity of some medications (including certain chemotherapeutics). The Johnson and Johnson vaccine contains polysorbate 80 – and some people who react to PEG will also react to polysorbate 80, so care must be taken.
For a full list of all additives (AKA excipients) in common vaccines check out the CDC Vaccine Excipient Summary
Natural Immunity – The Missing Link
Every news headline seems to focus on the vaccine and how many people have been vaccinated. But there is surprisingly little talk about the immune status of individuals who have already had a Covid-19 infection and thus have natural immunity. The Israeli health system maintains a robust database to study its population’s health. In a study of over 700,000 people comparing vaccinated individuals to those with natural immunity, they found the risk of developing symptomatic COVID-19 was 27 times higher among the vaccinated, and the risk of hospitalization eight times higher.
A second study out of the Cleveland Clinic among healthcare workers reinforced these findings, and they concluded that vaccinating persons who were previously infected confers no clear benefit. Yet, the CDC has recommended vaccination for all Americans regardless of previous infection – which is like saying all American adults should now get the chickenpox vaccine despite already having had chickenpox!
The CDC published its own data isolating the small state of Kentucky – ignoring its data on 49 other states – and determined out of a study group of 246 patients, that vaccination provided MORE protection than a previous infection. One would argue that isolating one state’s data – despite 49 other states reporting – is truly cherrypicking. Also the number of patients studied was very low – you would think the richest country in the world could do a a bit better.
I am NOT recommending people go out and get Covid infections for the superior immunity, but I do think consideration of previously infected status is warranted. Moreover, vaccines for younger children will likely be approved (and possibly mandated by schools) in the next month with total disregard for natural immunity – potentially vaccinating millions of children unnecessarily.
I feel the same concept holds true for my eczema patients – more on that below.
The Altered Immune System in Eczema, allergies, asthma
Although I would not characterize eczema patients as “immunocompromised,” there is clear evidence that their immune systems are malfunctioning. Eczema (AKA atopic dermatitis) is a step in the well-known “atopic march,” the progression of atopic or allergic diseases that also includes food allergies, allergic rhinitis (stuffy/runny nose), and asthma. Childhood onset of eczema often means the child may develop one of the other diseases later in life. Eczema sufferers actually have an overactive immune system related to multiple factors including a sick gut and altered microbiome, stress, and multiple other etiologies.
Eczema and traditional vaccines
Although vaccines in general have not been shown to be a primary cause of eczema, they may cause temporary worsening of eczema symptoms due to their excitement of our immune system. There are also definite cases of first onset eczema related to a vaccine dose, though it’s unlikely the vaccine was solely responsible (see bucket analogy below). One clear issue can occur in eczema patients who are sensitive to eggs and receive the MMR (measles,mumps,rubella) or flu vaccine which is made from egg protein. Egg issues aside, vaccines can simply add more volume to the “inflammatory bucket” which then overflows.
Historically, live weakened virus vaccines have been most associated with onset of eczema symptoms, likely due to the robust immune response seen with these vaccinations. However, recent studies out of Australia and Denmark have shown that by delaying the DTaP (Diptheria, tetanus, and pertussis) vaccination by one month, the subsequent incidence of eczema in those children decreases. And the DTaP vaccine only uses the protein toxoid, NOT a live or inactivated virus – so clearly there is more to the story than just live attenuated vaccines.
In a study of eczema patients who received the flu vaccine, patients who received the shot intramuscular (in the muscle) had a much better immune response than those who received the shot intradermal (in the skin) likely due to the staph living on the skin in severe eczema patients.
In children who are in the midst a severe eczema outbreak – red, itchy, inflamed and miserable, I will consider an alternative vaccine dosing schedule. I will then attempt to “drain” their inflammatory bucket by healing the gut, cleaning up the diet, reducing stress, managing histamines, etc. Once we have some space in the bucket, we can then vaccinate with less fear of a severe flair.
Eczema and Covid-19 Infection
Current data does NOT show that eczema patients are at increased risk of Covid-19 infection or severe complications from an infection. However, 16-20% of patients with Covid-19 infection will have skin manifestations of their disease – typically a papular rash. Sometimes a skin rash is the first sign of a new Covid infection. Of note, it can be difficult to tell if a rash is viral versus a transient eczema episode. Additionally, one study showed that 43% of patients with underlying eczema had worsening of their eczema symptoms during their covid infection.
The other major consideration is if the eczema sufferer has a compromised immune system from their treatment. Medications such as oral steroids, methotrexate, cyclosporine, and azathioprine all have major effects on the immune system and their capability to fight infection. Here is where it gets complicated – part of what makes Covid-19 infection so severe in some people is the inflammatory response they get in the later stages of infection. This leads to major inflammation in the lungs and the development of Acute Respiratory Distress Syndrome (ARDS) and puts people on ventilators. Some data has suggested that immunosuppressive drugs are likely harmful in the early stages of the disease (while the virus is replicating) but may actually be beneficial in the later stages to protect the lungs.
Let me intervene – I have been preaching the importance utilizing healthy diet, sugar restriction, gut healing, stress management, etc because they help regulate and right size our immune system! I think this a major reason that obesity is a major risk factor for severe Covid-19 infection – a proinflammatory state related to sugar, processed foods, food chemicals, a sick gut, and unrelenting stress.
Now that I got that off my chest – the current data suggests that eczema patients stay on their eczema medications. My goal is to get all patients off medication for eczema, and if you want more information on how, follow the link below.
The Covid-19 Vaccine and Eczema
The decision whether to vaccinate is one each family will need to make based off their particular situation. Currently, there is no convincing evidence that any of the eczema vaccines worsen eczema. Case reports do show several incidences of eczema eruptions after vaccination, although I was only able to find 3 cases and all were after the Pfizer vaccine. All 3 resolved with oral steroids and were in adults. Outside of these rare case reports, no studies exist showing concerns for vaccination in either worsening pre-existing eczema or leading to the onset of eczema at least in adults.
Immunosuppressive medications as discussed above including oral steroids, methotrexate, cyclosporine, azathioprine, and a number of anti-rheumatic drugs have been shown to significantly decrease the immune response to the influenza vaccine and the pneumococcal vaccine. However, the same effect has not been seen in the mRNA vaccines like Pfizer and Moderna – and the current recommendation is to continue these drugs during vaccination. I believe more study is needed to see if this hold true over time.
Topical steroids have NOT been shown to have any negative effect on vaccine efficacy. Dupilumab (Dupixent) which is the “latest and greatest” drug from big pharma for allergic disease, works by blocking interleukin-4, an important protein signaler in the immune system. Interestingly, despite the fact that it blocks an important part of the immune cascade, it is not considered an immunosuppressive drug. Nonetheless, many experts recommend waiting 72 hrs after a dose before obtaining the Covid-19 vaccine.
My Pandemic Thoughts
What I have seen through 18 months of this pandemic is the best defense against the Covid-19 virus is an optimized immune system. And this same concept hold true for the treatment of eczema and all the childhood autoimmune diseases. When will we realize that finding and addressing the root cause of illness is the solution, rather than creating an ever elaborate amount of medications to modify, suppress, and damage the immune system? When will we realize the best medicine we can take for any of these problems is quality food on our table? My mission remains to educate, inspire, and empower families to raise healthy kids in this unhealthy world.
The Current Numbers
The four graphs above summarize the following – despite the increase in cases amongst kids, hospitalization and death rates remain very low. Underlying medical issues significantly increase risk of hospitalization and severe illness.
Long Term Immunity
There is a lot of noise about antibodies after having COVID-19 and how long they last. Same for vaccines. But what do we really know? Stay with me for a nerdy second.
A closer look at the immune system. “To date, most studies of natural antibodies that block SARS-CoV-2 have zeroed in on those that target a specific portion of the spike protein known as the receptor-binding domain (RBD)” says Dr. Francis Collins from the NIH. The NIH published a study which showed that 84% of antibodies made by people infected with COVID-19 are targeting other parts of the spike protein. Not to mention that there are many other immune system cells involved in defending our bodies against COVID-19. One such group of cells, the T-cells, don’t attack the virus, but rather destroy infected cells. These cells appear to work regardless of COVID strain mutations, and may provide longer-term protection – NIH. However, only a few specialized laboratories offer this test. Lastly, even if you have a “good” number of cells, we don’t know what that means clinically.
In summary: We do not have enough reliable or accurate data to indicate how long the immune system is active against COVID-19 after infection or after immunizations. This viral strain is very new! The data is murky! People are scared!
The ONE thing we can count on is our immune system, and it is time to get it in tip top shape. It’s our only guarantee in this confusing world. If you would like to learn practical tips to optimize your immune system, join My Masterclass today!
To Vaccinate or Not Vaccinate
Generally speaking, healthy children without underlying conditions do NOT need to be vaccinated. Children are not super spreaders based on several studies done in schools last year. Children who might be candidates for the vaccine are those who do not have antibodies to Covid-19 AND have any of the following: morbid obesity, poorly controlled asthma, chronic lung and heart disease, or are severely immunocompromised AND have spoken with their doctor and evaluated the risk & benefits of vaccine vs illness. This is a new vaccine with unknown long term side effects and very small number of kids in the trials. An open discussion with your doctor is imperative to making the right decision for your family. You are not a bad person if you choose to vaccinate or choose not to vaccinate. Vaccines are a private discussion with a doctor, not with a local politician. I do not agree with school mandates for vaccinating children for COVID-19. There is simply not enough data to warrant mass vaccination or a mandate for kids.
Yours in Good Health,
Drs Ana-Maria and John Temple