# Is there a way to test your personal COVID vaccine response? How do corticosteroids impact response? 

Anyone have insight on (1) Whether there is a way to test how effective an immune response you had to the vaccine or (2) the extent to which inhaled glucocorticoids (specifically Symbicort) impact the effectiveness of the mRNA COVID vaccines (specifically Pfizer)? 

**On (1) there doesn't seem to be any useful test commercially available.**

*   [This 3/29/21 article from MD Anderson says](https://www.mdanderson.org/cancerwise/what-do-negative-positive-antibody-test-results-mean-after-a-covid-19-vaccine.h00-159459267.html):
    *   "The Centers for Disease Control and Prevention (CDC) discourages antibody testing [for assessing immunity](https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html) after getting the vaccine. A vaccinated person is very likely to get a negative result from a serology test, even if the vaccine was successful and protective. That’s because different serology tests detect antibodies to different parts of the virus. Some tests detect antibodies to the spike protein of the virus, which are produced in response to viral infection or the vaccine."
    *   (It's unclear why they / the CDC then refrain from suggesting that people use those latter tests.)
*   [This April 2021 article from Cleveland.com](https://www.cleveland.com/coronavirus/2021/04/can-a-test-tell-you-how-well-your-coronavirus-vaccine-is-working.html) (citing an expert at Cleveland Clinic) says:
    *   "There are tests that can provide some information about someone’s immune response to the vaccine, but those tests are conducted by labs and are not available for anyone to buy, said Dr. James Fernandez, an allergy and immunology expert at the Cleveland Clinic.The lab tests can detect the level of [Immunoglobulin G](https://www.hopkinsmedicine.org/health/conditions-and-diseases/igg-deficiencies) (IgG), the most common type of antibody that protects against infection, in someone’s blood. The problem is that experts don’t know what level of IgG is needed to constitute a “protective level,” Fernandez said.“We can’t faithfully or accurately or actively say what that means to you, \[whether\] you’re protected or not protected,” Fernandez said. “It’s just a number.”"
*   Apparently there are solutions to this under development, but not commercially available (or even past peer review):
    *   [https://www.npr.org/sections/health-shots/2021/04/28/991651498/new-blood-tests-should-show-how-long-a-covid-19-vaccine-will-protect-you](https://www.npr.org/sections/health-shots/2021/04/28/991651498/new-blood-tests-should-show-how-long-a-covid-19-vaccine-will-protect-you)
    *   [https://news.northwestern.edu/stories/2021/03/home-blood-test-for-covid-19-antibodies/](https://news.northwestern.edu/stories/2021/03/home-blood-test-for-covid-19-antibodies/)

**On (2): It seems inhaled corticosteroids should be fine:**

*The AAAAI emphatically says:* "No, there is no impact on an individual’s ability to respond to the vaccine and control of asthma is essential! There is no data to suggest that inhaled corticosteroids and/or leukotriene receptor antagonists impact on immunogenicity of the mRNA COVID-19 vaccines." 

(They seem to avoid the error of assuming that no evidence = no impact: they use different language when discussing another question on which "no information could be found and more information is needed" suggesting that they are not simply saying, "oh there are no studies on this so it's not a problem." They also seem to be speaking pretty specifically about Symbicort in that answer, since later they say "Daily oral steroids may interfere with the antibody response to the vaccine based on data with other immunosuppressives and flu vaccine.") ([https://education.aaaai.org/resources-for-a-i-clinicians/vaccines-qa_COVID-19](https://education.aaaai.org/resources-for-a-i-clinicians/vaccines-qa_COVID-19)) 

*Drugs.com somewhat confusingly says otherwise...*

However, drugs.com says there are moderate interactions between Symbicort and the Pfizer COVID vaccine: "If you are currently being treated or have recently been treated with budesonide, you should let your doctor know before receiving SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine. Depending on the dose and length of time you have been on budesonide, you may have a reduced response to the vaccine. In some situations, your doctor may want to delay vaccination to give your body time to recover from the effects of budesonide therapy. If you have recently been vaccinated with SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine, your doctor may choose to postpone treatment with budesonide for a couple of weeks or more

"... For SARS-CoV-2 (COVID-19) vaccines, vaccination should preferably be completed at least two weeks before initiation of immunosuppressive therapies; however, decisions to delay immunosuppressive therapy to complete COVID-19 vaccination should consider the individual's risks related to their underlying condition. Vaccines may generally be administered to patients receiving corticosteroids as replacement therapy (e.g., for Addison's disease)." 

([https://www.drugs.com/interactions-check.php?drug_list=432-2530,4221-19642](https://www.drugs.com/interactions-check.php?drug_list=432-2530,4221-19642))

*...but there's good reason to believe Symbicort is still fine:*

*   A physician friend remarked: There's a big difference between the dosage of inhaled steroid received like Symbicort (micrograms) and oral steroids (milligrams). Budesonide comes in multiple formulations and can be inhaled or oral. I would not consider patients taking inhaled corticosteroids as immunocompromised or immunosuppressed."
*   [MichaelLowe's comments below](https://www.lesswrong.com/posts/g4czkcto5XKGBE3FC/is-there-a-way-to-test-your-personal-covid-vaccine-response?commentId=XkLbjEP2oWye2Laua) support this (and suggest a potential reason why drugs.com may have reached this conclusion in error).