{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:56:25Z","timestamp":1767192985022,"version":"3.48.0"},"reference-count":20,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Chiba University Hospital"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,16]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Atopic dermatitis (AD) is a chronic inflammatory skin condition that impairs the quality of life of affected paediatric patients and their families. Dupilumab, an antagonist of the shared alpha chain subunit of the cytokines interleukin-4 and interleukin-13, has revolutionised the management of moderate-to-severe AD by effectively targeting type 2 inflammation. However, live attenuated vaccines, including live attenuated influenza vaccines (LAIVs), are contraindicated during dupilumab therapy owing to limited safety data. This restriction poses challenges to immunisation strategies, particularly in paediatric populations. This study aims to evaluate the safety and efficacy of LAIV in paediatric patients with AD undergoing dupilumab therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method and analysis<\/jats:title>\n                    <jats:p>This multicentre, prospective, single-arm, open-label trial will enrol 50 paediatric patients aged 2\u201318 years with AD undergoing dupilumab treatment. The participants will receive intranasal LAIV, followed by a 25-week observation period after vaccination. The primary outcome is the proportion of participants with a four-fold or greater increase in haemagglutination inhibition titres against influenza strains A(H1N1), A(H3N2) and B at 4\u2009weeks post vaccination. The secondary outcomes include the incidence of influenza and systemic or local adverse events, such as injection site reactions, fever and other influenza-like symptoms observed within 4\u2009weeks of vaccination. Exploratory endpoints include the evaluation of immunosuppressive markers such as neutrophil counts, lymphocyte subsets and serum immunoglobulin G levels. Safety analyses will assess the frequency of each adverse event, whereas efficacy analyses will focus on immunogenicity and influenza incidence during the 25-week follow-up period. This study aims to provide critical safety and immunogenicity data to guide immunisation strategies in biologically treated paediatric patients with AD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study complies with the principles of the Declaration of Helsinki and received ethics approval from the Institutional Review Board of Chiba University Hospital as a specified clinical trial. Informed consent and assent will be obtained as appropriate based on the participants\u2019 ages. These findings will be disseminated through peer-reviewed journals and scientific conferences to inform clinical vaccination strategies for biologically treated populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>jRCTs031240442.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101050","type":"journal-article","created":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T14:05:20Z","timestamp":1754229920000},"page":"e101050","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multicentre, prospective, single-arm, non-controlled, open-label trial to evaluate the safety and efficacy of live attenuated influenza vaccine in paediatric patients with atopic dermatitis undergoing dupilumab therapy: a protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6944-6161","authenticated-orcid":false,"given":"Toshiyuki","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hironori","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3342-3363","authenticated-orcid":false,"given":"Koo","family":"Nagasawa","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eri","family":"Hayata","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saori","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Kurihara","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taiji","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5835-8932","authenticated-orcid":false,"given":"Yoshihito","family":"Ozawa","sequence":"additional","affiliation":[{"name":"Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumiya","family":"Yamaide","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, International University of Health and Welfare Narita Hospital, Narita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuzaburo","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan"},{"name":"Department of Pediatrics, Eastern Chiba Medical Center, Togane, 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