# Immunosuppressants and common colds



## Mehita

This will be our first winter season with DS on an immunosuppressant and right now both of my boys are coming down with colds. Runny, stuffy noses, etc.

Can I treat his cold like I have in the past with basic cold meds? Do I need to consider doing anything different?

Generally, colds aren't worrisome, right? It's the bigger things like bacterial infections that we need to watch for?

How about the flu?

Is he just going to take longer to get over things? Or are they going to hit him harder?

Any input or experience is appreciated!


----------



## Jmrogers4

Our experience was he did get them while on immunosuppressents, just not often and they lasted just slightly longer then my other son but nothing really bad.  Generally treated with tylenol, vicks vapor rub, sudafed.
Hope he feels better soon, it is getting to be that time of year isn't it.


----------



## Tesscorm

Glad you asked   Stephen's first winter on remicade too.  Went to visit him over the weekend and, of course, he had a cold, cough... :shifty:  But, he seemed alright, said he was already getting over it after a couple of days... so I just let him be (with lots of 'call me or get to the doctor if... or if... and even if... :lol.  

Jacqui - forgot to send him vapor rub! :facepalm:  Always works like a charm, eh?!

Mehita - our GI said just to watch for fevers and yellowish coloured phlegm.  I've told Stephen to go to the school's health centre if he gets a fever without an obvious reason or if the fever doesn't go away with tylenol or by the next day.

As for the flu, I 'think' I'm going to have Stephen get the flu vaccine.  He always has before BUT he was never on remicade before??  AM going to doublecheck with his GP but I *think *the vaccine is recommended.


----------



## Clash

^^yep us too, fevers or yellowish phlegm warrant a doctor visit. C will get the flu shot as well.


----------



## Mehita

I tend to be in the camp that lets a fever run its course unless its super high or my boys are absolutely miserable. Should I not do this with DS anymore? At what temp do you get concerned?


----------



## Clash

I think because it was our first "outing" with an immunosuppressant I was probably hyper-vigilant, I'm not really certain if you should be quick to react to fevers now or not?


----------



## Patricia56

Our doctor's rules were:

Fevers over 100.5 that last longer than 24 hours = call doctor
Fevers over 101.5 twice in 12 hours = call doctor
Sore throat that lasts more than 1 day = visit doctor for strep test - even if there's no fever

The part of the immune system that is immune suppressed is not the part that fights off colds. So there should be no or little difference in the response to a viral illness. 

That said our son always took longer to improve and had multiple strep infections while he was on Humira/AZA

Ask your child's doctor for their rules about fevers at the next visit


----------



## Catherine

My daughter has had less colds and they have been less severe while on aza.

Our doctor seems concerned about sore neck or rashes with cold symptoms.


----------



## Sascot

I tend to stick to paracetamol and nose spray rather than cold meds.  If particularly stuffy/runny nose I may give an anti-histamine which does dry it up a bit, because I know that Cetrizine doesn't have any contra-indications for 6mp.  Tea is great if they have a cough - it does actually have an element that helps coughs (can never remember the name).


----------



## my little penguin

Same here fever = call Gi/ped ( since ped told us to call Gi )
Sore throat strep test ... DS did alot of those last year.
Colds he was fine
Just lots of strep throat.


----------



## crohnsinct

O was the healthiest person in the house.  Always has been though.  Remicade and mtx haven't changed anything for her.  We practice vigilent handwashing, and try to isolate the sick people in the house as much as possible.  

Our GI's rules fever of 101 call GI and he usually assesses and sends to ped for further assessment.  103 make appointment with GI.  Coughs that won't go away or with the yellow phlegm make appointment with GI.  Any other usual childhood thing like sore throats etc go to ped and ped reports to GI.


----------



## CrohnsKidMom

Both my boys have colds right now too, my older son is my IBDer.  Our GI said no big concerns with a cold or flu-just no ibuprofen, so we use Tylenol, vaporub, and nasal spray.  Our GI wasn't even really concerned about a fever, if it can be explained by the cold or flu.  If there's a fever with no cold/flu symptoms, that's cause for concern.  We'll all be getting flu shots this yr, so maybe that will help?!  It's free, so we probably should have been getting them all along.  Always thought that not getting the shot would strengthen your immune system.  Guess my IBDer's immune system is too strong... in the wrong way...


----------



## Johnnysmom

We needed to call with fever, the GI had us hold Johnny's meds for a few days while he had one.  

I agree with crohnsinct, Johnny was the healthiest one in our house too.  We always wash hands as soon as we enter our house, and always before eating.  He has hand wipes at school for when he doesn't have time to wash.  Anti bacterial gels only kill bacteria, not viruses so we don't use those.

I would call too since this is his first illness on meds.  Our GI nurse was glad we called and let us know in the future when we need to call or be concerned.  

Hope the boys are feeling better soon. ((((Hugs)))))


----------



## Clash

Oh wait I do remember C had a virus or something last year, fever that ran more than 3 days. The GI had us wait 48 hours after the fever ended to give him his MTX. So C usually took it on Friday but it changed to every Sunday due to that.


----------



## DanceMom

A has had a cold since being on 6-mp.  It seemed to last a little longer than usual (a little over a week) but her symptoms weren't severe and she didn't get a fever.  I always like to check with the GI when she isn't feeling well and let him make the call if he'd like to see her or have us visit the Pedi.


----------



## alex_chris

I am on aza, I'm having my first cold since March 2012 right now. It's not a bad cold (I am going to work anyway). My treatment is aspirin and tea. Plus, I'll be taking an eucalyptus oil bath in 5 minutes...


----------



## upsetmom

Winter just passed here.

It was my daughters first winter on Imuran and she had the cold / flu every few weeks. A few times l gave her cold and flu tablets but they didn't seem to help so we just let it run its course....which was usually a week. 

Next winter she'll be getting the flu shot.


----------



## Mehita

The middle school nurse just called. Chicken pox at the elementary school already! We've only been in school 12 days. That's crazy. DS is at the middle school, and has been vaccinated, so I'm not too worried, but I'm just floored at how quickly it's hit. Lice too!


----------



## Tesscorm

Just to confirm...  are there no concerns with having the flu vaccine while on remicade?


----------



## Patricia56

Avoid the flu-mist that is squirted into the nose as it has live vaccine.

Otherwise there is no reason to avoid having flu vaccinations that I know of. Our Ped GI STRONGLY recommends them.

One of the problems with CDers getting upper respiratory illnesses that are severe is that they often set off a flare.


----------



## my little penguin

DS got the flu "shot " while on remicade last year no issues .
He will get the shot this year while on humira .


----------



## CrohnsKidMom

Mehita, you mention chicken pox going around... I remember our GI said it's not cause for huge concern if my immunosuppressed IBDer gets a cold or flu, but it's a different matter if he gets something like chicken pox.  I was too scared to ask what would happen, but now I want to know.  Has anyone had this experience?

My kids have been vaccinated against chicken pox, but I've been told it just reduces their risk of catching it.  Great.


----------



## my little penguin

Chicken pox or flu can have complications when you are immmunocompromised .
Pneumonia being on of them and can be fatal.


> Chickenpox in the immunocompromised child
> Authors
> For the majority of children who are immunocompromised or who require immunosuppression, their primary diagnosis necessitates a difficult programme of prolonged treatment. In countries with no varicella vaccination, this is compounded by the ever-present and significant threat of chickenpox. Potential exposures must be avoided, causing children to miss school and playgroups whenever chickenpox is at large. Each contact with varicella results in negotiating blood testing to assess their current varicella zoster virus (VZV) status followed by either varicella zoster immunoglobulin (VZIG) therapy or antiviral treatment in hospital or five times a day at home. Immunosuppressive treatment may be interrupted with consequent risk of reduced remission rates, or disease relapse.
> Before the availability of VZIG and antiviral agents, the death rate from varicella was around 7% for children being treated for cancer, with 32% having visceral dissemination; children with lymphopenia were at highest risk.1 Since the use of prophylaxis and treatment, deaths from varicella are now very rare.2 However, without careful management of varicella exposure, there remains a risk of severe disseminated disease, with the development of varicella pneumonia, encephalitis, hepatitis, or haemorrhagic complications.3 Despite the best preventive interventions, child deaths still occur.4
> The number of immunocompromised children is unknown but is thought to be increasing, including children with primary immunodeficiencies, acquired immunodeficiency and those that are immunosuppressed by treatment including novel biological therapies. This is not a homogenous population; those with impaired T cell function are particularly susceptible to severe varicella.


From:
http://m.adc.bmj.com/content/early/2012/05/04/archdischild-2012-301684


----------



## Mehita

I'm sitting here with my non-IBD kid asleep in my lap.  He's miserable. DS went to school a little stuffy this morning, but came home happy as a lark. Go figure. I'm all worried about DS when it's the little guy who is a mess. I don't think he'll be going to school tomorrow. One less day of chicken pox and lice exposure. I'm good with that!

On the chicken pox front... so if kids were vaccinated and his titer shows he's been previously exposed, yet now he's immune suppressed... what exactly does that all mean? Does being immunesuppressed void out the vaccine, so to speak? Because for normal folks, even if you've been vaccinated you can still get the pox, but it might just be a lighter version. So how does that translate to immune suppressed people?


----------



## Catherine

Sorry to crash your thread.

How much more concerned should be when the common cold turns into bronchitis?

Is bronchitis a reason to try get a adult/child to spent another day at home.

She has both Crohn's and asthma.


----------



## Patricia56

Yes to Catherine about the bronchitis - just my Laymom's opinion of course. And of course it depends on whether she is doing well. Maybe try for a half day if she's doing pretty well - that way she's home for breathing treatments before and after.

Getting a fast handle on respiratory problems will help keep her from flaring since URI can lead to CD flares.


----------



## Patricia56

Chicken Pox positive titer is supposed to mean that your immune system recognizes the Varicella virus and will produce antibodies specifically geared to killing off those little invaders.

It is possible to have a positive titer and still get CP but it usually presents as a much milder version and may have an atypical presentation (according to the CDC).

If your whole family  has not had their titers checked I suggest  you have that done to make sure one of the other children doesn't bring it home. And being vaccinated does not guarantee you have a positive titer.

The biggest problem with CP is that it can spread to the internal organs (think lungs = pneumonia or intestines = FLARE) causing very serious, even life-threatening illness.

Hope it goes away and whoever didn't immunize their kid decides they made a mistake and gets them their other shots ASAP.


----------



## Sascot

My son has jut started a bad cold/sore throat - his first proper one since starting 6mp. Never made it back to school after I got him for lunch. Hoping no fever develops! Trying to keep him away from my daughter as its her birthday party on Sunday!


----------



## DustyKat

Such fab advice that I don't have anything to add on that Mehita.  

So Sarah on Aza for 7 years and Matt nearly 3. Neither has had a serious in that time. They have each had the odd Winter viral infection but to be honest I reckon they seem to have a quicker recovery time. Mr. Kat and I have both just recovered from a nasty URTI and Matt didn't even get a sniffle! 

Dusty. xxx


----------



## Lisa

I have gotten the flu shot every year for at least the past 20 years or so.....I've nto really gotten any sicker than anyone else in the household, in fact I'm usually the one taking care of everyone else. 

I do feel like I'm getting a cold right now though, past 2 mornings I've woken up with a sinus headache, and the right side of my nose is stuffy.....I have dealt with strep a few times, had pneumonia once (no hospital though) and some sinus infections.....over all, I will take those in exchange for not flaring and having fistulas!!!!!

My doctor's advice as far as not getting sick - make sure to wash hands, wash hands, wash hands!!!  Personal hygeine is key.


----------



## Mehita

My non-IBDer has a sinus and ear infection. Just started amoxicillin today. I should keep the kids away from each other now for sure, right? They've mostly been avoiding each other anyway...


----------



## hawkeye

Gotten the flu shot every year as well for the past 15 years. In terms of a cold and being on Imuran, my experience over 22 years (since age 18 in 1991) is that there is not a big difference in the number or severity of colds.

The only thing that has changed the number of colds I get is having a toddler going to daycare.


----------



## tricky789

As long as its not the live vaccine you are fine I recently had one myself cheers and good luck


----------

