Airline Travel Guidance for Patients on Upadacitinib
Patients with severe atopic dermatitis taking upadacitinib can safely travel by air without specific travel restrictions, but should ensure they have completed herpes zoster vaccination before travel and maintain their medication regimen during the trip. 1
Pre-Travel Vaccination Requirements
Herpes zoster vaccination is critical before initiating upadacitinib therapy and should be completed before any travel plans. 1, 2 The increased risk of herpes zoster infection with JAK inhibitors (affecting <3% of patients) makes this vaccination essential for preventing complications during travel. 1
The inactivated recombinant zoster vaccine (Shingrix, two-dose series) is preferred for patients over 18 years. 1 If unavailable, the live zoster vaccine (Zostavax) should be administered at least 3-4 weeks before starting upadacitinib. 1
COVID-19 vaccination with non-live vaccines should be completed, with consideration of pausing JAK inhibitor treatment for 1 week after vaccination to ensure adequate immune response, though this should follow local health authority guidelines. 1
Medication Management During Travel
Continue upadacitinib 15 mg or 30 mg once daily without interruption during air travel. 2 There are no specific contraindications to flying while on this medication.
Carry sufficient medication supply for the entire trip plus extra days in case of travel delays, keeping medication in original packaging with prescription information. 1
For patients on the 30 mg dose who have achieved disease control, consider whether dose reduction to 15 mg is appropriate before extended travel, though this should be planned well in advance of the trip. 2
Infection Risk Considerations
The modest increase in infection risk with upadacitinib does not preclude air travel but requires awareness of potential complications. 1 Herpes zoster infections occur in <3% of patients and are typically mild to moderate. 1
Eczema herpeticum rates are low but can occur; patients should be educated to recognize early signs (disseminated vesicular eruption) and seek immediate medical attention if symptoms develop during travel. 1
Tuberculosis risk is minimal in atopic dermatitis patients on JAK inhibitors, but baseline TB testing should have been completed before starting therapy. 1 No additional TB precautions are needed for routine air travel.
Skin Care During Flight
Maintain aggressive moisturization during flight due to low cabin humidity, which can exacerbate atopic dermatitis regardless of systemic therapy. 1
Continue concomitant topical corticosteroids as prescribed, particularly if the patient was enrolled on combination therapy. 3
Pack topical medications in carry-on luggage to ensure access during flight and in case checked baggage is delayed.
Common Pitfalls to Avoid
Do not discontinue upadacitinib for travel. The medication has demonstrated sustained efficacy through 140 weeks of continuous use, and interruption may trigger disease flare. 4
Avoid assuming that acne or folliculitis developing during travel represents infection requiring antibiotic therapy; these are common adverse effects (affecting up to 17% on 30 mg dose) that typically respond to standard acne treatments. 1
Do not delay seeking medical care if severe headache, abdominal pain, or signs of infection develop, as these require evaluation even though most cases are mild and self-limited. 1
Age-Specific Considerations
At 56 years of age, this patient falls below the threshold for heightened cardiovascular concerns (≥50 years with cardiovascular risk factors), but baseline cardiovascular risk assessment should have been completed before initiating therapy. 2
No age-specific travel restrictions apply to this patient population on upadacitinib. 5, 6
Laboratory Monitoring
Routine laboratory monitoring (liver enzymes, lipids, blood counts, renal function) should be up to date before extended travel, but short trips do not require special testing. 1
For extended international travel (>4-8 weeks), consider scheduling laboratory monitoring according to the product monograph recommendations before departure. 1