Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Treatment Options in Gastroenterology
Erschienen in: Current Treatment Options in Gastroenterology 4/2018

06.10.2018 | Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)

Update on Vaccinating the Patient With Inflammatory Bowel Disease

verfasst von: Jennifer Coukos, MD, Francis A. Farraye, MD, MSc

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

Patients with inflammatory bowel disease (IBD) are at increased risk of infectious diseases independent of their immunosuppression status, and yet, studies suggest that this population is not receiving standard vaccinations at the same rate as the general population. This review seeks to understand why IBD patients may not be receiving recommended immunizations and to provide guidelines on vaccinating this vulnerable population.

Recent findings

Inactive vaccines are recommended for patients with IBD regardless of immunosuppression status due to the increased risk for many vaccine-preventable illnesses. Certain live vaccines can be administered to the immunocompromised patient with IBD. Additionally, many patients with IBD will be immunosuppressed some time in their disease course, further increasing their risk for infection. Despite this understanding, patients with IBD have poor vaccination rates. Inadequate knowledge, limited time with patients, and lack of consensus as to who is responsible for identifying and administering vaccinations are some of the most important barriers to vaccinating the patient with IBD.

Summary

In this review, we discuss guidelines for vaccinating both the immunocompetent and immunosuppressed patient with IBD as well as provide vaccine-specific recommendations. The evidence suggests that patients with IBD are not receiving recommended vaccinations because of misconceptions on the part of patients as well as a paucity of knowledge by their health care team. Educational programs can be successfully implemented to increase knowledge about appropriate vaccinations and can ultimately increase vaccine uptake among patients with IBD. In the end, gastroenterologists and primary care physicians must work together with their patients with IBD to ensure that recommended vaccinations are administered.
Literatur
1.
Melmed GY, Ippoliti AF, Papadakis KA, Tran TT, Birt JL, Lee SK, et al. Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses. Am J Gastroenterol. 2006;101(8):1834–40.CrossRef
2.
Selby L, Kane S, Wilson J, Balla P, Riff B, Bingcang C, et al. Receipt of preventive health services by IBD patients is significantly lower than by primary care patients. Inflamm Bowel Dis. 2008;14(2):253–8.CrossRef
3.
• Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017;112(2):241–58 These guidelines by the ACG address the safety and appropriate timing of vaccinations in IBD patients. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system is used to evaluate the strength of each recommendation.CrossRef
4.
Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1–48.PubMed
5.
Wasan SK, Baker SE, Skolnik PR, Farraye FA. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol. 2010;105(6):1231–8.CrossRef
6.
• Reich J, Wasan S, Farraye FA. Vaccinating patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2016;12(9):540–6 In addition to outlining appropriate vaccinations, this article discusses strategies for improving vaccination rates among patients with IBD.
7.
Rubin L, Levin M, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309–18.CrossRef
8.
• Greveson K, Shepherd T, Mulligan JP, et al. Travel health and pretravel preparation in the patient with inflammatory bowel disease. Frontline Gastroenterol. 2016;7(1):60–5 This study showed that only a minority of patients with IBD seek pretravel advice and many providers do not feel comfortable providing this advice. A majority of clinicians would refer to a specialty clinic regardless of their confidence level. This article suggests that there still exists a need for greater education of patients with IBD prior to foreign travel.CrossRef
9.
Wasan SK, Coukos JA, Farraye FA. Vaccinating the inflammatory bowel disease patient: deficiencies in gastroenterologists knowledge. Inflamm Bowel Dis. 2011;17(12):2536–40.CrossRef
10.
Yeung JH, Goodman KJ, Fedorak RN. Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients. Inflamm Bowel Dis. 2012;18(1):34–40.CrossRef
11.
• Gurvits GE, Lan G, Tan A, Weissman A. Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA. Postgrad Med J. 2017;93(1100):333–7 This study demonstrates that primary care physicians have a poor understanding and comfort in regards to appropriate vaccinations for patients with IBD.CrossRef
12.
Christensen KR, Steenholdt C, Buhl SS, Ainsworth MA, Thomsen OØ, Brynskov J. Systematic information to health-care professionals about vaccination guidelines improves adherence in patients with inflammatory bowel disease in anti-TNFα therapy. Am J Gastroenterol. 2015;110(11):1526–32.CrossRef
13.
Reich JS, Miller HL, Wasan SK, Noronha A, Ardagna E, Sullivan K, et al. Influenza and pneumococcal vaccination rates in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2015;11(6):396–401.
14.
Wasan SK, Calderwood AH, Long MD, Kappelman MD, Sandler RS, Farraye FA. Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement. Inflamm Bowel Dis. 2014;20(2):246–50.CrossRef
15.
Sands BE, Cuffari C, Katz J, Kugathasan S, Onken J, Vitek C, et al. Guidelines for immunizations in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2004;10(5):677–92.CrossRef
16.
Melmed GY. Vaccination strategies for patients with inflammatory bowel disease on immunomodulators and biologics. Inflamm Bowel Dis. 2009;15(9):1410–6.CrossRef
17.
• Tinsley A, Navabi S, Williams ED, et al. Increased risk of influenza and influenza-related complications among 140,480 patients with inflammatory bowel disease. Inflamm Bowel Dis. 2018; https://​doi.​org/​10.​1093/​ibd/​izy243 This is the first study designed to evaluate the incidence and severity of influenza in patients with IBD.
18.
• Grohskopf LA, Sokolow LZ, Fry AM, et al. Update: ACIP recommendations for the use of quadrivalent live attenuated influenza vaccine (LAIV4)—United States, 2018–19 influenza season. MMWR Morb Mortal Wkly Rep. 2018;67:643–5 The updated ACIP guideline states that despite changing recommendation over the past few years, the live attenuated influenza vaccine (LAIV4) is an effective option for flu protection during the 2018–2019 season.CrossRef
19.
Andrisani G, Frasca D, Romero M, Armuzzi A, Felice C, Marzo M, et al. Immune response to influenza a/H1N1 vaccine in inflammatory bowel disease patients treated with anti TNF-α agents: effects of combined therapy with immunosuppressants. J Crohns Colitis. 2013;7(4):301–7.CrossRef
20.
• DeBruyn J, Fonseca K, Ghosh S, et al. Immunogenicity of influenza vaccine for patients with inflammatory bowel disease on maintenance infliximab therapy: a randomized trial. Inflamm Bowel Dis. 2016;22(3):638–47 Response to influenza vaccine is reduced in patients on infliximab. However, this study demonstrated that the timing of vaccine relative to infliximab infusion did not affect the achievement of serologic protection.CrossRef
21.
Melmed GY. Vaccinations while on thiopurines: some protection is better than none. Am J Gastroenterol. 2012;107(1):141–2.CrossRef
22.
Matsumoto H, Ohfuji S, Watanabe K, Yamagami H, Fukushima W, Maeda K, et al. Booster influenza vaccination does not improve immune response in adult inflammatory bowel disease patients treated with immunosuppressives: a randomized controlled trial. J Gastroenterol. 2015;50(8):876–86.CrossRef
23.
Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of pneumonia among patients with inflammatory bowel disease. Am J Gastroenterol. 2013;108(2):240–8.CrossRef
24.
Kantsø B, Simonsen J, Hoffmann S, Valentiner-Branth P, Petersen AM, Jess T. Inflammatory bowel disease patients are at increased risk of invasive pneumococcal disease: a nationwide Danish cohort study 1977-2013. Am J Gastroenterol. 2015;110(11):1582–7.CrossRef
25.
Kobayashi M, Bennett NM, Gierke R, Almendares O, Moore MR, Whitney CG, et al. Intervals between PCV13 and PPSV23 vaccines: recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2015;64(34):944–7.CrossRef
26.
Melmed GY, Agarwal N, Frenck RW, Ippoliti AF, Ibanez P, Papadakis KA, et al. Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease. Am J Gastroenterol. 2010;105(1):148–54.CrossRef
27.
Visvanathan S, Keenan GF, Baker DG, Levinson AI, Wagner CL. Response to pneumococcal vaccine in patients with early rheumatoid arthritis receiving infliximab plus methotrexate or methotrexate alone. J Rheumatol. 2007;34(5):952–7.PubMed
28.
Bhatia J, Bratcher J, Korelitz B, Vakher K, Mannor S, Shevchuk M, et al. Abnormalities of uterine cervix in women with inflammatory bowel disease. World J Gastroenterol. 2006;12(38):6167–71.CrossRef
29.
Kane S, Khatibi B, Reddy D. Higher incidence of abnormal pap smears in women with inflammatory bowel disease. Am J Gastroenterol. 2008;103(3):631–6.CrossRef
30.
Allegretti JR, Barnes EL, Cameron A. Are patients with inflammatory bowel disease on chronic immunosuppressive therapy at increased risk of cervical high-grade dysplasia/cancer? A meta-analysis. Inflamm Bowel Dis. 2015;21(5):1089–97.CrossRef
31.
Petrosky E, Bocchini JA Jr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64(11):300–4.PubMedPubMedCentral
32.
• Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2016;65:1405–8 The ACIP guidelines continue to recommend a 3-dose vaccine series for HPV if the vaccine is given at ages 15 through 26 years and for immunocompromised patients. However, the updated guidelines now support a 2-dose series if the vaccine is given at ages 9 through 14 years.CrossRef
33.
Jacobson DL, Bousvaros A, Ashworth L, Carey R, Shrier LA, Burchett SK, et al. Immunogenicity and tolerability to human papillomavirus-like particle vaccine in girls and young women with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(7):1441–9.CrossRef
34.
Hou JK, Velayos F, Terrault N, Mahadevan U. Viral hepatitis and inflammatory bowel disease. Inflamm Bowel Dis. 2010;16(6):925–32.CrossRef
35.
Tolentino YF, Fogaca HS, Zaltman C, et al. Hepatitis B virus prevalence and transmission risk factors in inflammatory bowel disease patients at Clementino Fraga Filho university hospital. World J Gastroenterol. 2008;14(20):3201–6.CrossRef
36.
Xunrong L, Yan AW, Liang R, Lau GK. Hepatitis B virus (HBV) reactivation after cytotoxic or immunosuppressive therapy--pathogenesis and management. Rev Med Virol. 2001;11(5):287–99.CrossRef
37.
Pérez-Alvarez R, Díaz-Lagares C, García-Hernández F, Lopez-Roses L, Brito-Zerón P, Pérez-de-Lis M, et al. Hepatitis B virus (HBV) reactivation in patients receiving tumor necrosis factor (TNF)-targeted therapy: analysis of 257 cases. Medicine (Baltimore). 2011;90(6):359–71.CrossRef
38.
Esteve M, Saro C, González-Huix F, Suarez F, Forné M, Viver JM. Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis. Gut. 2004;53(9):1363–5.CrossRef
39.
Morisco F, Castiglione F, Rispo A, Stroffolini T, Sansone S, Vitale R, et al. Effect of immunosuppressive therapy on patients with inflammatory bowel diseases and hepatitis B or C virus infection. J Viral Hepat. 2013;20(3):200–8.CrossRef
40.
Michel M, Duvoux C, Hezode C, Cherqui D. Fulminant hepatitis after infliximab in a patient with hepatitis B virus treated for an adult onset Still’s disease. J Rheumatol. 2003;30(7):1624–5.PubMed
41.
• Jiang HY, Wang SY, Deng M, et al. Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: a systematic review and meta-analysis. Vaccine. 2017;35(20):2633–41 This meta-analysis demonstrated poor serological response to hepatitis B vaccine in patients with IBD and provided several predictive variables for level of immune response.CrossRef
42.
Cekic C, Aslan F, Krc A, et al. Evaluation of factors associated with response to hepatitis B vaccination in patients with inflammatory bowel disease. Medicine (Baltimore). 2015;94(22):e940.CrossRef
43.
Altunöz ME, Senateş E, Yeşil A, et al. Patients with inflammatory bowel disease have a lower response rate to HBV vaccination compared to controls. Dig Dis Sci. 2012;57(4):1039–44.CrossRef
44.
• Schillie S, Harris A, Link-Gelles R, et al. Recommendations of the advisory committee on immunization practices for use of a hepatitis B vaccine with a novel adjuvant. MMWR Morb Mortal Wkly Rep. 2018;67(15):455–8 In July 2017, the FDA approved a new 2-dose hepatitis B vaccine (Heplisav-B, Dynavax) which can be given over one month compared to the 3-dose series over 6 months required for the older hepatitis B vaccines.CrossRef
45.
Cardell K, Akerlind B, Sällberg M, Frydén A. Excellent response rate to a double dose of the combined hepatitis a and B vaccine in previous nonresponders to hepatitis B vaccine. J Infect Dis. 2008;198(3):299–304.CrossRef
46.
Urganci N, Kalyoncu D. Immunogenecity of hepatitis a and B vaccination in pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;56(4):412–5.CrossRef
47.
Park SH, Yang SK, Park SK, Kim JW, Yang DH, Jung KW, et al. Efficacy of hepatitis a vaccination and factors impacting on seroconversion in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2014;20(1):69–74.CrossRef
48.
Radzikowski A, Banaszkiewicz A, Łazowska-Przeorek I, Grzybowska-Chlebowczyk U, Woś H, Pytrus T, et al. Immunogenecity of hepatitis a vaccine in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(5):1117–24.CrossRef
49.
Patton ME, Stephens D, Moore K, MacNeil JR. Updated recommendations for use of MenB-FHbp serogroup B meningococcal vaccine—advisory committee on immunization practices, 2016. MMWR Morb Mortal Wkly Rep. 2017;66:509–13.CrossRef
50.
Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2018;67(RR-2):1–44.CrossRef
51.
• Caldera F, Saha S, Wald A, et al. Lower sustained diphtheria and pertussis antibody concentrations in inflammatory bowel disease patients. Dig Dis Sci. 2018;63(6):1532–40 This study is first to evaluate sustained protection against diphtheria and pertussis in patients with IBD.CrossRef
52.
Dezfoli S, Horton HA, Thepyasuwan N, Berel D, Targan SR, Vasiliauskas EA, et al. Combined immunosuppression impairs immunogenicity to tetanus and pertussis vaccination among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1754–60.CrossRef
53.
Gupta G, Lautenbach E, Lewis JD. Incidence and risk factors for herpes zoster among patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4(12):1483–90.CrossRef
54.
Long MD, Martin C, Sandler RS, Kappelman MD. Increased risk of herpes zoster among 108 604 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(4):420–9.CrossRef
55.
56.
• Yun H, Yang S, Chen L, et al. Risk of herpes zoster in autoimmune and inflammatory diseases: implications for vaccination. Arthritis Rheumatol. 2016;68(9):2328–37 This study found that younger patients with IBD have higher rates of shingles compared to older, healthy controls.CrossRef
57.
• Dooling KL, Guo A, Patel M, et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines. MMWR Morb Mortal Wklyl Rep. 2018;67:103–8 The updates ACIP guidelines include the use of the recombinant zoster vaccine (Shingrix) that was approved in October 2017. This recombinant vaccine can be used in immunosuppressed patients unlike the live vaccine (Zostavax) which is contraindicated in patients on high level immunosuppression.CrossRef
58.
Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2008;57:1–30.PubMed
59.
• Wasan SK, Zullow S, Berg A, et al. Herpes zoster vaccine response in inflammatory bowel disease patients on low-dose immunosuppression. Inflamm Bowel Dis. 2016;22(6):1391–6 This study demonstrated that while patients with IBD on low-dose immunosuppression have a reduced response to the herpes zoster vaccine, they are not at an increased risk for serious adverse events.CrossRef
60.
Tsai SY, Yang TY, Lin CL, Tsai YH, Kuo CF, Kao CH. Increased risk of varicella zoster virus infection in inflammatory bowel disease in an Asian population: a nationwide population-based cohort study. Int J Clin Pract. 2015;69(2):228–34.CrossRef
61.
Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2007;56(RRA-4):1–40.PubMed
62.
• Cleveland NK, Rodriquez D, Wichman A, et al. Many inflammatory bowel disease patients are not immune to measles or pertussis. Dig Dis Sci. 2016;61(10):2972–6 This study was the first to assess measles immunity and the largest study to assess pertussis titers in patients with IBD. The results revealed that a significant number patients with IBD lack immunity to measles and pertussis.CrossRef
63.
McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2013;62(4):1–34.PubMed
64.
Loubet P, Verger P, Abitbol V, Peyrin-Biroulet L, Launay O. Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: results from a web-based study. Dig Liver Dis. 2018;50(6):563–7.CrossRef
65.
66.
67.
Parker S, Chambers White L, Spangler C, Rosenblum J, Sweeney S, Homan E, et al. A quality improvement project significantly increased the vaccination rate for immunosuppressed patients with IBD. Inflamm Bowel Dis. 2013;19(9):1809–14.PubMed
68.
Elder KG, Lemon SK, Costello TJ. Increasing compliance with national quality measures for stroke through use of a standard order set. Am J Health Syst Pharm. 2015;72(11 Suppl 1):S6–S10.CrossRef
69.
Khoury L, Dangodara AA, Lee JA, Lovejoy M, Amin AN. Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures. Hosp Pract (1995). 2014;42(5):89–99.CrossRef
70.
Karr JR, Lu JJ, Smith RB, Thomas AC. Using computerized physician order entry to ensure appropriate vaccination of patients with inflammatory bowel disease. Ochsner J. 2016;16(1):90–5.PubMedPubMedCentral
71.
Malhi G, Rumman A, Thanabalan R, Croitoru K, Silverberg MS, Hillary Steinhart A, et al. Vaccination in inflammatory bowel disease patients: attitudes, knowledge, and uptake. J Crohns Colitis. 2015;9(6):439–44.CrossRef
72.
Coenen S, Weyts E, Jorissen C, de Munter P, Noman M, Ballet V, et al. Effects of education and information on vaccination behavior in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(2):318–24.CrossRef
73.
Metadaten
Titel
Update on Vaccinating the Patient With Inflammatory Bowel Disease
verfasst von
Jennifer Coukos, MD
Francis A. Farraye, MD, MSc
Publikationsdatum
06.10.2018
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 4/2018
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-018-0200-4

Weitere Artikel der Ausgabe 4/2018

Current Treatment Options in Gastroenterology 4/2018 Zur Ausgabe

Stomach (P Malfertheiner, Section Editor)

Helicobacter pylori Infection: New Facts in Clinical Management

Pancreas (V Chandrasekhara, Section Editor)

Update on the Prevention of Post-ERCP Pancreatitis

Invited Commentary

Timing of Endoscopic Necrosectomy Following Transmural Stent Placement for Pancreatic Necrosis

Motility (H Parkman and R Schey, Section Editors)

Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders

Endoscopy (P Siersema, Section Editor)

Selection of EMR and ESD for Laterally Spreading Lesions of the Colon

Stomach (P Malfertheiner, Section Editor)

Gastric Cancer: an Evolving Disease

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise