Does Dupixent (dupilumab) interact with the influenza vaccine?

Dupixent and Influenza Vaccine: No Clinically Significant Interaction

Dupixent (dupilumab) does not interact with the inactivated influenza vaccine, and patients should receive their annual flu shot without interrupting dupilumab treatment. 1, 2

Recommended Vaccine Type

• Use only the inactivated (intramuscular) influenza vaccine in patients on dupilumab—this is the standard injectable flu shot given in the arm. 1
• Avoid the live attenuated intranasal vaccine (FluMist) as the FDA label recommends avoiding live vaccines during dupilumab treatment due to theoretical concerns, though emerging evidence suggests even live vaccines may be safe. 2, 3

Timing and Administration

• Administer the inactivated flu vaccine at any routine visit during flu season without adjusting or delaying dupilumab doses. 1
• No need to hold dupilumab before or after vaccination—the inactivated vaccine can be given on the same day as a dupilumab injection or at any interval. 1
• Optimal vaccination timing is September through November, though vaccination should continue throughout the influenza season as long as vaccine is available. 4, 1

Why This Is Safe

The inactivated influenza vaccine contains killed virus particles that cannot replicate, making it fundamentally different from live vaccines. 4 Dupilumab blocks IL-4 and IL-13 signaling but does not cause broad immunosuppression like traditional immunosuppressants (corticosteroids, rituximab, or TNF inhibitors). 1 The mechanism of dupilumab does not interfere with the immune response to inactivated vaccines. 2

Key Clinical Distinctions

Dupilumab is NOT a traditional immunosuppressant. 1 It selectively blocks type 2 inflammation without broadly suppressing immune function. This is why:

• Inactivated vaccines (flu, pneumococcal, COVID-19, hepatitis) can be given without special precautions. 1
• No dose adjustments or treatment interruptions are needed. 1
• Vaccine efficacy appears preserved in dupilumab-treated patients. 3, 5

Common Pitfalls to Avoid

Do not confuse dupilumab with high-dose corticosteroids or other immunosuppressants that require special vaccination protocols. 1 Patients on prednisone ≥20 mg/day need different considerations, but dupilumab does not fall into this category. 6

Do not delay influenza vaccination waiting for a "perfect" time in the dupilumab dosing schedule—any time during flu season is appropriate. 4, 1

Do not inadvertently give the intranasal live vaccine (FluMist) when the patient requests "the nasal spray"—always verify you're administering the inactivated intramuscular formulation. 2

Emerging Evidence on Live Vaccines

While the FDA label recommends avoiding live vaccines during dupilumab treatment 2, recent high-quality evidence challenges this precaution:

• A 2024 systematic review and expert Delphi consensus from the American College of Allergy, Asthma and Immunology concluded that vaccines (including live vaccines) can likely be administered safely to dupilumab-treated patients through shared decision-making. 3
• A 2022 study of 37 asthma patients who received live attenuated yellow fever vaccine while on dupilumab showed 100% achieved seroprotection with no vaccine-related adverse events, despite therapeutic dupilumab levels. 5
• A 2024 case series of 9 children with severe atopic dermatitis who received MMR ± varicella vaccines while on dupilumab reported no adverse events within 4 weeks post-vaccination. 7

However, for influenza vaccination specifically, this debate is moot—the inactivated vaccine is universally recommended for all adults and is the standard of care, making the live vaccine question irrelevant for routine practice. 4, 1

Practical Implementation

• Document in the chart that the patient received inactivated (not live) influenza vaccine. 4
• Administer at separate anatomic sites if giving other vaccines simultaneously (e.g., pneumococcal vaccine in opposite arm). 4
• Continue dupilumab on schedule—no dose should be skipped or delayed for vaccination. 1
• Reassure patients that the flu shot will not interfere with their dupilumab treatment or worsen their underlying condition. 1