By Kelli Hancock
higher risk of getting the flu with Crohn's or ulcerative colitis

Medically reviewed by Shannon Chang, MD

During this time of year, there’s higher incidence of upper respiratory infections, such as common colds and influenza. While a cold can make you miserable, the flu knocks you down and keeps punching.

For people with inflammatory bowel disease, influenza can be an even bigger problem than for other folks. According to researchers from Pennsylvania State University, the risk of influenza and influenza-related complications is higher among people with IBD.

Higher Risk of Catching the Flu for People with IBD

In the 2018 study published online in the journal Inflammatory Bowel Diseases, the Penn State Hershey researchers used an American insurance claims database to identify the 140,480 IBD patients, along with an equal number of non-IBD patients.

Among the nearly 300,000 people studied from January 2008 to December 2011, the risk of contracting influenza was approximately 30% higher among the people with IBD. This is even after statistically adjusting for factors that might affect results such as coexisting medical conditions, immunosuppressive medication use, and healthcare utilization rates.

For unclear reasons, researchers also found that the risk was slightly higher for people with Crohn’s disease than it was for people with ulcerative colitis (UC).

To assess whether IBD contributed to a higher incidence of influenza-related complications, researchers looked for development of pneumonia or hospitalization within 30 days of the original diagnosis of the flu. They found that pneumonia diagnoses were not significantly higher among people with IBD when compared with non-IBD patients. However, the rates of hospitalization were almost three times higher among the people with IBD.

Could it Be Medication-Related?

Because many of the medications used to treat Crohn’s and UC suppress the immune system, these medications may make patients more susceptible to various kinds of infections. The Penn State researchers aimed to determine which, if any, of the medications used to treat IBD were associated with increased risk of influenza.

They used a study design called nested-case control to determine this, which focused exclusively on people with IBD this time. Each of the IBD patients who had been diagnosed with influenza was matched with three IBD patients who did not get influenza during the study period. The matching criteria included sex, age, geographical region, type of IBD (Crohn’s or UC), and duration of follow-up.

The result: Steroids (such as prednisone) were the only class of medication that was associated with an increased risk of contracting the flu.

Tips to Prevent the Flu

Sobering data, isn’t it? Here are a few tips to help reduce your risk of catching the flu over the upcoming seasons.

  1. Wash your hands.
    Did you just touch that doorknob? Better wash them again.
  2. Avoid others who are ill.
    Yep, that means telling the grandkids not to come over if they have the sniffles. It also may mean that you sleep in the guest bedroom to avoid getting your spouse’s illness.
  3. Stay home if you aren’t feeling well.
    Don’t be the person who infects the entire office or classroom. This is why you have sick days.
  4. Talk to your doctor about whether the flu vaccine is right for you.
    There are a myriad of reasons for and against the flu vaccine, many of them individual and deeply personal. Discuss any concerns you may have about the flu shot and your risk of catching the flu with your doctor. Also, there are several different vaccine formulations available. So if you do plan to get vaccinated, make sure you know which formulation is best for you. Any patient on immunosuppressing medications should opt for the inactivated flu vaccination and avoid the live vaccine.
  5. If you think you have the flu, go to the doctor as soon as possible.
    There are medications available to shorten the duration of your symptoms, but they must be started soon after you first notice symptoms. Don’t try to “tough it out.” Seek medical attention right away.
  6. Practice self-care.
    Get plenty of rest, maintain your exercise routine and eat a well-balanced diet to keep yourself healthy during flu season, which also happens to be a common time of year for IBD flares.

Medical reviewer and Oshi physician-partner Shannon Chang, MD is a gastroenterologist specializing in IBD at NYU Langone Health’s Inflammatory Bowel Disease Center in New York City. Her clinical interests include J-pouches, pregnancy in IBD, and in-patient IBD management. Dr. Chang is an Assistant Professor of Medicine, as well as the Associate Program Director for the Gastroenterology Fellowship. She completed her internal medicine residency at Mount Sinai Hospital and her gastroenterology fellowship at NYU.

Oshi is a tracking tool and content resource. It does not render medical advice or services, and it is not intended to diagnose, treat, cure, or prevent any disease. You should always review this information with your healthcare professionals.