GPs advised not to administer asthma biologics alongside COVID vaccine

The new update to the Australian Asthma Handbook has confirmed that monoclonal antibody therapies, such as omalizumab, mepolizumab, benralizumab and dupilumab – often referred to as biologics – do not interfere with the coronavirus vaccines.
 
Professor Nick Zwar, GP and Chair of the Guidelines Committee, told newsGP that GPs should advise patients with asthma to continue taking their regular medicines, including the time at which they would get vaccinated.
 
‘This includes oral corticosteroids used short term to manage asthma flare-ups in people with asthma, or long term to manage severe asthma in a very small proportion of patients,’ he said.
 
However, Professor Zwar says GPs should avoid administering biologics on the same day as a COVID vaccine, where possible.
 
‘If someone’s got severe asthma, try not to give their injectable biological on the same day as a COVID vaccine,’ he said.
 
‘Not that there’s a danger in that. It’s just that if you had a reaction, you wouldn’t know which one it was to.
 
‘We’ve just said not on the same day, so that would probably be a few days or something like that. But just try to avoid the same day.’
 
The handbook also reiterates that unless unavoidable, nebulisers should not be used to administer inhaled medicines.
 
The new recommendations were released to coincide with the commencement of phase 1b of the rollout of the Oxford University/AstraZeneca vaccine. The handbook also advises GPs to reassure their patients that having asthma or allergic rhinitis does not prevent them from having a coronavirus vaccination or increase the risk of adverse reactions.
 
Professor Zwar says the National Asthma Council Australia is encouraging people with asthma to be vaccinated by their GP as soon as adequate doses are available.
 
‘As we know, vaccine hesitancy is clearly an issue among some people,’ he said.
 
‘[So] we are advising health professionals to reassure their patients that having asthma, including severe asthma or allergic rhinitis, does not prevent someone having a COVID-19 vaccination or increase the risk of adverse reactions.’
 
According to the Federal Government’s vaccine roadmap, people with chronic lung disease, including chronic obstructive pulmonary disease, cystic fibrosis and interstitial lung disease are eligible under phase 1b. However, those with mild-to-moderate asthma will have to wait a while longer.
 
Professor Zwar says this is an opportunity for GPs to discuss with their patients the best time to get the influenza vaccination.
 
‘GPs are dealing with a whole lot of questions about where people are prioritised, and that’s tricky for everybody because some people would like to be further up the priority list than the rollout has them positioned for that,’ he said.
 
‘Health professionals should reassure their asthma patients that they don’t need to wait until they have the COVID-19 vaccine to get the flu vaccine.
 
‘Given that supply of COVID-19 vaccines is limited, it is likely that [the] flu vaccine will become available first.
 
‘GPs can also best advise their asthma patients on the recommended interval between a dose of seasonal influenza vaccine and a dose of COVID-19 vaccine.’
 
Professor Zwar said while the commencement of the vaccination campaign is a positive for all Australians, that it is a particularly welcome step for those with a long-term health condition such as asthma.
 
‘Their vulnerability to getting more severely ill with COVID is higher, and that’s something the vaccines seem to be good at; protecting against any sort of severe disease,’ he said.
 
‘It may not prevent transmission – we’re yet to know that. But they do seem to work well against preventing people getting severe COVID. That’s a great reassurance for all of us.’
 
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