The MastAttack 107: The Layperson’s Guide to Understanding Mast Cell Diseases, Part 64

78. Are vaccines contraindicated for people with mast cell disease?

  • What I describe here is a summary of the current state of expert recommendations on this topic. These are not the personal opinions of Lisa Klimas.
  • Generally, vaccines are not contraindicated based solely upon having mast cell disease.
  • The big reason for this is that we know for sure that infections are mast cell activating, in addition to the array of other issues caused by having a condition serious enough to require vaccination.
  • The idea is that if you have a mast cell reaction to a vaccine, it may still grant enough protection against a specific condition, or cross coverage for related conditions, that it may be worth it. Of course, whether or not this is the case depends on a LOT of factors.
  • Vaccination will cause some level of mast cell activation in everyone, mast cell patient or otherwise. This is part of the immune response a person generates that gives them immunity from the vaccine. There is no confusion about whether or not vaccines cause mast cell activation. They do. Every time.
  • It is my experience that the patients who react worst to vaccination are patients with mast cell activation syndrome rather than those with systemic or cutaneous mastocytosis. This is my view from 10,000 feet. There are, of course, exceptions.
  • It is also my experience that the patients who react worst to vaccination often do so because they have another condition where vaccination is contraindicated, like a metabolic disorder. Additionally, I find that many of those patients also have primary immunodeficiencies, meaning they may not be able to generate a vaccine response at all, therefore making vaccination a pointless endeavor for those particular people.
  • So there are some mast cell patients who should not receive vaccines. This is not, usually, because of their mast cell disease. For most of my mast cell patienthood, I have been pretty reactive. I am fully vaccinated and continue to receive vaccines as needed.
  • Mast cell patients should be aware that the normal premedication for procedures has to be modified for vaccination. Specifically, you can’t use systemic corticosteroids for two weeks prior to vaccination in order for the vaccination to be effective. (This excludes patients taking the dose equivalent of 6 mg prednisone or less daily.) This means that antihistamines are the primary method of premedication for vaccination.
  • (Author’s note: I have gotten lots of questions about corticosteroids and vaccination. Corticosteroids are immunosuppressive so they suppress your body’s ability to generate immunity to anything, including a vaccine. If a patient receives either continuous or short burst low dose corticosteroids within two weeks before or after vaccination, most providers feel there is still benefit. However, doses above this blunt the immune response and can cause an ineffective vaccine response. As always, please speak with your provider about how this specifically applies to you. It is possible there are scenarios that this does not cover. As always, this is not medical advice.)
  • Also, I am no way diminishing or arguing that vaccines cannot cause injuries. This post is not to address that.