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Lupus Flare After Flu Shot? Question of the Day Here

Do Flu Shots Cause Lupus Flares? Lupus flare after flu shot?

Question of the day: Dr. Thomas, I have lupus and was told by another lupus patient that she gets a flare when she gets a flu shot. Do flu shots cause lupus flares?  – JP
ANSWER: “No and Yes; in that order”

Fortunately, the vast majority of systemic lupus erythematosus (SLE) patients do not get a flare after getting the flu shot. A recent study showed that only 32 SLE patients out of 1966 (1.6%) who got the flu shot (influenza vaccine) had flares from their SLE, and all were mild. I have never had a patient get a severe flare from the flu shot over 30 years. I had one severe flare from Pneumovax, though.

Now the really interesting thing about this study is as follows… it would be very easy to conclude “the flu shot must cause flares in 1.6% of SLE patients.” However, that is not true. Imagine studying 1966 SLE patients even for just a very short period of time. I find it amazing that only 32 out of 1966 would flare. You’d expect more of them to flare during the study period simply because that is what lupus likes to do.

Compared to healthy controls, they responded very well to the vaccine as far as it protecting them from the flu.

It is flu season. Please get your flu shot. Especially with COVID-19, we do not want a one-two punch!

NOTE: The Centers for Disease Control recommends getting the flu shot BEFORE the end of October.

(Many people misinterpret this as they should get it in October). Their only warning about this is that elderly vaccine recipients may have the vaccine response be a little weaker at the end of the flu season if they get it in July or August. Otherwise, it is best to get it as soon as it is available to help decrease community spread.

Please SHARE my post with others.

Click the COMMENTS button above regarding your experience with the flu shot when you have lupus. Would love to hear from people who have had no problems at all and those who have.

– by Don Thomas, MD, FACP, FACR

12 Comments

  1. No flare from flu shot.

  2. I get my flu shot faithfully every year for as long as I can remember. I often feel vaguely unwell for a day or two afterward, and just take it easy. Last year, I had a slight lupus flare from the shot. My fatigue and body aches kept me in bed for about 4 days. Then I was fine. I think the risk is worth the benefit, and I’m getting my 2020 flu vaccination tomorrow.

    • Nancy: So glad to hear that. Rational thinking on your part! We need more voices like yours on the internet. I already got mine as well. I do practice what I preach.

  3. I have never had more problems than the average person with the flu shot. I did have an enhanced reaction and slight flare with the pneumonia shot, but the flu shot has always been fine. My reaction to the pneumonia shot would NOT be enough to make me not get one again. So if anyone is concerned about reactions, please get your vaccinations.

  4. Thank you for your comments, Heather!

  5. Well this really helped me with questions I’ve had for years. Looks like it’s a flu shot for me! Thank you!!

    • Debbie: I’m so happy to have another convert. I’ve seen so many influenza horror cases and deaths in my career, yet no severe reaction to the flu shot. They do occur, and are rare (such as Guillain-Barre syndrome). The benefits outweigh the risks. I compare it to driving 100 miles to see your grandma. The chances of getting into a severe accident on that trip are worse than a severe reaction to the flu shot. However, the benefits (a piece of grandma’s pie and her love) outweigh the risks… stay healthy and safe! … Dr T

  6. I found this very useful. I have SLE and I get flu shot every year, but I was advised by another lupus patient to not get vaccinations done as it can make me feel worse. It made me worried but I felt deep inside that it’s okay. Her lupus is very advanced, a lot of damaged done already… she is in constant flare and immunisations make it worse, however, my one is still stable enough. I never had any major flare ups after flu shot which made me realise even for a healthy person, it is advised to not get flu shot if they have a cold or feel unwell until they get better, the same for lupus patients, we have to make sure that we feel well enough to have it so it wouldn’t make our symptoms worse. We need to be patient.

  7. I just started on Saphnelo infusions. How will taking other preventive vaccines work with this particular infusion? It is so new, there is not much research on it.

    Thank you

    • Gaile: The data for effectiveness (especially for rashes and arthritis) and safety are very exciting. The primary side effect seen in the clinical trials were episodes of shingles. I’d encourage all patients to get their Shingrix shots (at least their first one) before starting. You get one, followed by another 2-6 months later. The FDA approved it for 18 year olds and older who are on immunosuppressants (like Saphnelo). We do not know its effects, yet, on COVID vaccines. If I were a betting man, I’d bet “probably not much.” This is based upon data that other cytokine inhibitors (such as TNF inhibitors) have not shown negative impacts on COVID spike protein antibody responses. … Good luck and I hope you do well on anifrolumab (Saphnelo). …Donald Thomas, MD

  8. Thanks for the information, but unfortunately I do get really sick when I get the Flu shot.

    • Sorry to hear that, Laura. Individual patients absolutely can have reactions. And I do personally believe that vaccines can rarely cause lupus flares or even for lupus to occur (I’ve seen it happen). This just shows that in a large patient population that there is no statistical proof for it. But when it involves yoursel, it can be a major issue.

      Thanks for the comment so others can know they are not alone

      Dona.d Thomas, MD


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