Biologic medications have revolutionized the treatment of autoimmune diseases like rheumatoid arthritis, psoriasis, and Crohn's disease. By targeting specific proteins in the immune system, they reduce inflammation and disease progression. However, this also means the immune system's ability to fight off infections is altered, necessitating specific precautions. Proper medication management, dietary choices, and lifestyle habits are crucial for minimizing health risks while on biologic therapy.
Live Vaccines are Strictly Prohibited
One of the most important things to avoid when on biologics is receiving a live attenuated vaccine. These vaccines use a weakened, but still living, version of a virus to trigger an immune response. For individuals with a healthy immune system, this is safe. However, for those with a suppressed immune system from biologics, the vaccine could cause a serious infection.
Types of live vaccines to avoid
- Measles, mumps, and rubella (MMR)
- Nasal spray flu vaccine (FluMist)
- Varicella (chickenpox)
- Shingles (Zostavax) – the newer, non-live recombinant vaccine (Shingrix) is safe
- Yellow fever
- Oral typhoid
- Oral polio
Patients should ideally receive any necessary live vaccines at least four weeks before starting biologic therapy. For ongoing treatment, it is vital to check that any vaccination is non-live or inactivated and to consult with your doctor or pharmacist beforehand.
Dietary Precautions to Reduce Foodborne Illness
Since biologics increase susceptibility to infection, certain food safety measures are essential to prevent food poisoning. Raw or undercooked foods and unpasteurized products can harbor bacteria, viruses, or parasites that a weakened immune system struggles to combat effectively.
Foods to handle with caution
- Raw or undercooked meat, poultry, and seafood: Cook all animal products to their recommended internal temperatures. For example, enjoy sushi with cooked fish or opt for vegetarian rolls.
- Raw eggs: Fully cook eggs and avoid foods with raw or undercooked egg components, such as homemade mayonnaise, salad dressings, or raw cookie dough.
- Unpasteurized milk and dairy products: Only consume milk and dairy that have been pasteurized, as the heating process eliminates harmful bacteria like listeria and salmonella.
- Mold-ripened soft cheeses: Avoid soft cheeses like Brie, blue cheese, feta, and Camembert, which can carry a risk of fungal infection.
- Raw sprouts: Alfalfa, bean, and other sprouts can carry a higher risk of bacterial contamination.
- Leftovers: Reheat leftovers thoroughly to 165°F and store them properly to prevent bacterial growth.
Alcohol and Drug Interactions
While moderate alcohol consumption may be acceptable for some, it's crucial to discuss this with your healthcare provider. Both alcohol and certain biologic therapies can increase the risk of liver damage and potentially reduce the medication's effectiveness. The risk is particularly heightened if you are also taking other liver-affecting drugs, like methotrexate. Chronic alcohol use also further suppresses the immune system, increasing overall infection risk.
Managing Infections and Illness
Patients on biologics need to be vigilant for signs of infection, which can include fever, cough, and unexplained fatigue. If a severe infection occurs, the biologic medication may need to be temporarily stopped. It is important to inform your doctor right away if you feel unwell or develop symptoms of an infection.
- Mild or moderate infection: You may continue your biologic as normal but should monitor your symptoms closely.
- Severe infection: You should pause your biologic dose and contact your healthcare provider immediately. Your biologic can typically be restarted once the infection has resolved.
- Avoiding others: To minimize infection risk, it is best to avoid people with contagious illnesses, like a severe cold, flu, or stomach bug.
Surgery and Medical Procedures
If you are planning an elective surgery, your doctor will likely advise you to temporarily stop your biologic medication beforehand to minimize the risk of infection and complications with healing. For emergency surgery, it is critical to inform the medical team that you are on a biologic. Your healthcare provider will give specific instructions on when to pause and restart treatment.
Biologics vs. Inactivated Vaccines
| Feature | Live Attenuated Vaccines | Inactivated Vaccines (Killed Vaccines) |
|---|---|---|
| Immune System Impact | Uses a weakened, living virus that could replicate and cause illness in an immunosuppressed patient. | Contains a killed or inactive microbe that cannot cause disease. |
| Safety on Biologics | Strictly contraindicated due to high risk of severe infection. | Safe for patients on biologics, though effectiveness may vary. |
| Examples | MMR, nasal spray flu, shingles (Zostavax), yellow fever. | Flu shot, recombinant shingles (Shingrix), pneumococcal vaccines, tetanus. |
| Timing | Must be given before starting biologic therapy (typically 4 weeks prior). | Can be given while on biologic therapy, but efficacy may be reduced. |
Conclusion
Being on biologic therapy requires careful attention to health and lifestyle choices. Avoiding live vaccines, taking precautions with certain foods, being mindful of alcohol consumption, and closely monitoring for infections are all crucial steps. Your healthcare provider is your best resource for personalized advice and guidance. Open communication and adherence to these safety measures can significantly reduce risks and ensure you get the most benefit from your biologic treatment. For detailed information on specific biologic drugs and safety guidelines, you can consult resources such as the U.S. National Library of Medicine.
