{"id":16037,"date":"2023-07-20T09:12:41","date_gmt":"2023-07-20T08:12:41","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=16037"},"modified":"2025-01-07T13:43:02","modified_gmt":"2025-01-07T13:43:02","slug":"recurrent-shingles-immune-deficiency","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/immunology\/recurrent-shingles-immune-deficiency\/","title":{"rendered":"Recurrent Shingles & Immune Deficiency"},"content":{"rendered":"\n

This is a brief guide relating to patients having recurrent (twice or more in 1 year) episodes of shingles, who are also aged > 70 years. The current Green Book recommendation is to seek advice around tests \/ evaluation regarding whether the patient has an underlying immune deficiency to explain the propensity to recurrent shingles.<\/p>\n\n\n\n

Please note that where there is concern around significant immune deficiency, live vaccinations are contra-indicated.<\/strong><\/p>\n\n\n\n

A clinical approach to evaluating for any significant immune deficiency in this setting would include:<\/p>\n\n\n\n

    \n
  1. Confirm the diagnosis of recurrent shingles, wherever possible, by sending a blister swab for HSV & VZV. Recurrent herpes simplex is much more common than recurrent shingles<\/em> \u2013 and often misdiagnosed, especially when it occurs at sites other than the lip. Recurrent herpes simplex would not be a contra-indication to shingles vaccination unless there was other evidence of immune suppression. <\/li>\n\n\n\n
  2. Clinical evaluation: is there a history of severe \/ persistent \/ unusual \/ recurrent other infections at all to raise concerns about cellular immune deficiency? This may include oesophageal candidiasis \/ pneumocystis infections \/ opportunistic infections.<\/li>\n\n\n\n
  3. If isolated shingles only \u2013 then is this classical appearance or very severe \/ multiple dermatomes and not responsive to conventional treatment?<\/li>\n\n\n\n
  4. The most common cause for immune deficiency (especially in this age group) is secondary immune deficiency \u2013 so this includes lymphoma \/ haematological malignancy\/ other malignancy \/ diabetes \/ immunosuppression medications like biologics & steroids etc \u2013 so these should be excluded clinically.<\/li>\n\n\n\n
  5. HIV testing\u2013 this is an HIV indicator condition<\/a><\/li>\n\n\n\n
  6. Check lymphocyte count on FBC (+\/- consider checking CD4+ T-cell count on peripheral blood sample)<\/li>\n\n\n\n
  7. Check immunoglobulins and electrophoresis.<\/li>\n<\/ol>\n\n\n\n

    If any concerns \/ abnormalities raised on above 7 checkpoints, then further evaluation as appropriate may be required (e.g. Infectious Diseases referral for HIV positive patients<\/a>).<\/p>\n\n\n\n

    If no concerns \/ abnormalities in terms of the above, then it is highly unlikely that there is an underlying immune deficiency in the patient.<\/p>\n\n\n\n

    (Authors: Charu Chopra on behalf of Scottish Immunologists\u2019 Group)<\/p>\n\n\n\n

    C.M. & C.C. 07-01-25<\/strong><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    This is a brief guide relating to patients having recurrent (twice or more in 1 year) episodes of shingles, who are also aged > 70 years. The current Green Book recommendation is to seek advice around tests \/ evaluation regarding whether the patient has an underlying immune deficiency to explain the propensity to recurrent shingles.<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4037,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[965],"class_list":["post-16037","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-recurrent-shingles-immune-deficiency"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" Recurrent Shingles & Immune Deficiency<\/a>","rttpg_excerpt":"This is a brief guide relating to patients having recurrent (twice or more in 1 year) episodes of shingles, who are also aged > 70 years. The current Green Book recommendation is to seek advice around tests \/ evaluation regarding whether the patient has an underlying immune deficiency to explain the propensity to recurrent shingles.","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16037","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=16037"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16037\/revisions"}],"predecessor-version":[{"id":22386,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16037\/revisions\/22386"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4037"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=16037"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=16037"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}