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J Allergy Clin Immunol. 2014 Feb;133(2):439-47. doi: 10.1016/j.jaci.2013.10.037. Epub 2013 Dec 10.

Transcutaneous yellow fever vaccination of subjects with or without atopic dermatitis.

Author information

  • 1Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Ore. Electronic address:
  • 2Department of Pediatrics, National Jewish Health, Denver, Colo.
  • 3Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Ore.
  • 4Department of Dermatology, Oregon Health & Science University, Portland, Ore.
  • 5Rho, Inc, Chapel Hill, NC.
  • 6Division of Dermatology, University of California San Diego, La Jolla, Calif.



Atopic dermatitis (AD) is a common inflammatory skin disease with a global prevalence ranging from 3% to 20%. Patients with AD have an increased risk for complications after viral infection (eg, herpes simplex virus), and vaccination of patients with AD with live vaccinia virus is contraindicated because of a heightened risk of eczema vaccinatum, a rare but potentially lethal complication associated with smallpox vaccination.


We sought to develop a better understanding of immunity to cutaneous viral infection in patients with AD.


In a double-blind randomized study we investigated the safety and immunogenicity of live attenuated yellow fever virus (YFV) vaccination of nonatopic subjects and patients with AD after standard subcutaneous inoculation or transcutaneous vaccination administered with a bifurcated needle. Viremia, neutralizing antibody, and antiviral T-cell responses were analyzed for up to 30 days after vaccination.


YFV vaccination administered through either route was well tolerated. Subcutaneous vaccination resulted in higher seroconversion rates than transcutaneous vaccination but elicited similar antiviral antibody levels and T-cell responses in both the nonatopic and AD groups. After transcutaneous vaccination, both groups mounted similar neutralizing antibody responses, but patients with AD demonstrated lower antiviral T-cell responses by 30 days after vaccination. Among transcutaneously vaccinated subjects, a significant inverse correlation between baseline IgE levels and the magnitude of antiviral antibody and CD4(+) T-cell responses was observed.


YFV vaccination of patients with AD through the transcutaneous route revealed that high baseline IgE levels provide a potential biomarker for predicting reduced virus-specific immune memory after transcutaneous infection with a live virus.

Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.


AD; AE; Adverse event; Atopic dermatitis; IgE; LNI; Log neutralizing index; NT(50); Neutralizing titer 50; T-cell memory; YFV; Yellow fever virus; antibody; atopic dermatitis

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