Divided dose flu shot--- is this a good idea?

carolm · Post by **carolm** » Mon Sep 10, 2012 11:42 am

Hi all,
My PCP will be on me to get a flu shot and as a school district employee I always have, except for last year when I was on Entocort and trying to get well.

This year my PCP mentioned that for some people with compromised immune systems she will divide the flu shot into two doses. You get 1/2 of the dose, then 2 weeks later receive the other half.

What are your thoughts on this? I know some of you have had flares because of flu shots. Is there any evidence that a divided dose will work better or be less risky?

thanks
Carol

cjbndtsn · Post by **cjbndtsn** » Mon Sep 10, 2012 11:51 am

Hi Carol,
Is there a reason you didn't get a flu shot while on Entocort??? Just curious because I have been on it now for 2 1/2 weeks but last Wed I went to my family doc and he gave me my flu shot and pnemonia shot both full strength. I never had any reactions to either other than a little achy arm. I'm assuming that if I would have reacted I would have done it by now and I didn't really see any difference because of being on the Entocort. I just wondered if there is something that I should watch for at this point.
thanks

Zizzle · Post by **Zizzle** » Mon Sep 10, 2012 12:47 pm

Carol,
I can't undrstand the logic for a divided flu shot. If they are referring to the typical "immune compromised" and they feel the shot won't take the first time, maybe they are dividing it to ensure a reaction?? In the case of MC, IMHO we are not immune supressed (even on Entocort I imagine), we are more likely to have an OVERREACTION to the shot and its ingredients. I know in my case (with more developed autoimmune markers), my doctors have told me no shots for anything -- I have a medical exemption. Anything that stimulates/irritates your immune system, be it shot or infection, has the potential to trigger an autoimmune or GI flare.

Post by **tex** » Mon Sep 10, 2012 12:54 pm

The reaction risk connected with these vaccinations are related to mast cell issues. IOW, they are risky for someone who has mast cell activation disorder (MCAD) because they can trigger an anaphylactic response. Statistically, I would calculate that compared with a full dose, a half dose would probably be about 75% as likely to trigger an adverse event. The question is, "Would the second injection increase the odds?". The answer depends on whether you view the 2 injections as isolated events, or related events.

Cathy, if you didn't react within a half hour of receiving the shot, then you should have nothing to worry about.

Tex

carolm · Post by **carolm** » Mon Sep 10, 2012 6:09 pm

Cathy-- I didn't get the flu shot last year at this time because I was very sick. Even on Entocort I was struggling, dropping 2 even 3 pounds a week and could eat maybe 5 foods. There were several people on this site that said that their last big flare was due to getting the flu shot. I wasn't willing to stress my body or my immune system any more than it already was. As Zizzle said anything that puts your immune system in action, has the potential to start a flare.

Zizzle and Tex, my feeling was the same as yours-- if a person is truly going to react then a lower dose shouldn't make any difference. My thought was "I'd probably flare twice instead of once" if I got the divided dose.

Thanks for sharing your insight,

Carol

cjbndtsn · Post by **cjbndtsn** » Mon Sep 10, 2012 8:52 pm

Carol and Tex,
See those are the things I'm really just learning about here. Had I heard that info earlier I probably would've waited to get the shots while going through the healing. THis is all just so new to me that I had no idea that could affect the MC. THank goodness I did NOT react like so many others have had. That is another thought I will keep in the back of my mind for future issues though.

thanks again

mbeezie · Post by **mbeezie** » Tue Sep 11, 2012 4:48 am

The flu vaccine is what started my illness 5 years ago, and it was mast cell related. It triggered a cytokine storm and hypertensive crisis (other symptoms followed). I was not allergic (based on testing) and at the time doctors had no idea what happened to me. I know others on this forum have had flu shot reactions as well, but none as severe as mine.

If you choose to get the flu shot I suggest asking for a preservative free shot. Thimersol is the preservative used and I know of at least one study that showed that it triggered mast cell degranulation.

Mary Beth

carolm · Post by **carolm** » Tue Sep 11, 2012 10:54 am

Thanks Mary Beth. If I get brave enough to get a flu shot I'll ask for preservative free.

carol

Zizzle · Post by **Zizzle** » Tue Sep 11, 2012 11:39 am

I totally agree. They sometimes say the Thimerisol free shots are reserved for pregnant women and young children, but I would hope they would give it to you for having an AI disease. This will mean you CANNOT have a divided dose, since it comes in a pre-filled syringe (Fluzone).

carolm · Post by **carolm** » Tue Sep 11, 2012 4:55 pm

Zizzle, I'm okay with not having a divided dose. I couldn't see the advantage to that in my case.

I actually don't know what I will do.

thanks
Carol

Gloria · Post by **Gloria** » Wed Sep 12, 2012 7:44 pm

I got the flu shot last year while I was taking 3 Entocort a day and didn't have any reaction. I'll probably get it again this year, mainly because I'm over 65 and at higher risk for complications from the flu.

Gloria