Kiara Horwitz, 34, a publicist in New York City, knows this firsthand. She’s never taken immunosuppressant drugs to treat her Crohn’s, but she still caught the flu in summer 2019, which triggered a flare-up. “I landed up in the ER,” she says. “My doctor put me on centralized steroids until [I recovered].” Horwitz says that even the common cold sends her to bed for days and causes her symptoms to flare. “I think this is linked to anxiety about being sick,” she says. “Whenever I have high anxiety or stress, which can also lead to a cold or flu, it can affect my stomach.” While everyone gets sick from time to time, there are ways you can reduce the severity of your illnesses and keep your Crohn’s symptoms in check. Here’s what you need to know about colds and the flu if you have Crohn’s.
1. You may be more likely to get the flu — even if you’re not on immunosuppressants.
It’s true that immunosuppressant medications, which are commonly prescribed for people with Crohn’s and work by suppressing the immune system to help treat inflammation in the GI tract, can make people with Crohn’s more susceptible to the common cold and flu. People with inflammatory bowel disease (IBD) who take immunosuppressive medications can be at risk for not only the cold and flu but also pneumonia and other infectious diseases, says Taha Qazi, MD, a gastroenterologist and IBD specialist at Cleveland Clinic in Ohio. But something about Crohn’s disease itself may also predispose people to catching a cold or the flu. A study published in July 2011 in the journal Viruses suggests that a gene mutation associated with Crohn’s disease causes faulty cell autophagy — the cleaning up of damaged cells as well as bacteria and viruses — which makes it harder for the body to fight off infections. Dr. Qazi also points to a study published in July 2018 in the journal Inflammatory Bowel Diseasesthat examined more than 140,000 people’s medical records and found that people with IBD were more likely to contract the flu than those without IBD, regardless of whether they were taking corticosteroids. “Crohn’s disease is an autoimmune condition that can lead to higher susceptibility to infections, even if [people aren’t] on any medications,” says Alyssa Parian, MD, a gastroenterologist who specializes in IBD at Johns Hopkins Medical Center in Baltimore, Maryland. “[This could be] due to alterations in the immune system, which has a decreased ability to fight off bacteria and viruses.” “At least anecdotally, it seems my IBD patients take a couple more weeks to recover than patients without IBD,” says Qazi.
3. You need to get the flu shot every year, not the nasal flu vaccine.
The most important way to prevent flu complications is to get the flu vaccine every year, which the Centers for Disease Control and Prevention (CDC) recommends specifically for people who take corticosteroids or other immune-suppressing drugs. But that doesn’t mean everyone is following doctor’s orders: In a study published in April 2015 in the Journal of Crohn’s and Colitis, only about 60 percent of people with IBD had been immunized against the flu. “I battle with patients routinely about vaccine status,” says Qazi. “The flu shot not only decreases the risk of contracting the flu, but if you do get the flu, it decreases the severity of the flu,” says Dr. Parian, who adds that because people with Crohn’s are also at greater risk of a secondary bacterial pneumonia infection, it’s also important to get the pneumonia vaccine. That said, people with IBD who are on immunosuppressant drugs should never get live vaccines, such as the nasal flu vaccine, which contain a modified live flu virus, because it can be more dangerous to people who have a weakened immune system. Instead, get the flu shot, which contains the inactive (killed) virus. A few other simple, everyday actions can help you steer clear of germs that can make you sick:
Wash your hands with soap and water for at least 20 seconds before preparing or eating food and after using the toilet. If you don’t have access to soap and water, use a hand sanitizer that’s at least 60 percent alcohol.Try to avoid touching your eyes, nose, and mouth, which is how many people get exposed to germs.As much as possible, try to avoid close contact with people who are sick.
In addition to getting the flu shot, Horwitz credits weekly acupuncture, a healthy diet, and workouts five days a week for helping keep her immune system strong.
4. If you do catch the flu, you should see your doctor (and possibly start antivirals) immediately.
Think you have the flu? It’s critical to check in with your doctor right away to get tested and, if necessary, begin treatment. Antiviral medications for the flu are really only effective if started within 48 hours of the first symptoms, according to the CDC. “It’s important to catch it as soon as possible to prevent problems from escalating,” says Qazi. Symptoms of the flu include:
FeverCoughSore throatRunny or stuffy noseBody achesHeadacheChills and fatigueVomiting and diarrhea — sometimes (more common in children than adults)
Antiviral medications keep the flu virus from replicating, which helps shorten the time you’re sick and prevent serious flu complications. Be sure to take the full course your doctor prescribes. Protect others by staying home until at least 24 hours after your fever disappears and by covering your nose and mouth with a tissue when you cough or sneeze.
5. You may not need to stop taking your Crohn’s medications.
While you should always talk to your doctor about your treatment plan, Qazi says people with IBD don’t usually need to stop taking their meds if they catch the flu. “There’s a reason you’re on medication therapy,” he says. “When you get off, it can make the disease course worse.” But your doctor’s recommendations may vary. “Depending how severe it is, your doctor might recommend holding your medications,” adds Parian.
6. It’s extra important to stay hydrated.
It’s more important than ever to drink plenty of liquids if you get sick. Fever commonly associated with the flu increases the risk of dehydration, which is compounded by Crohn’s symptoms like diarrhea. Keep an eye on your urine. It should be pale yellow; if it’s the color of dark straw or amber, you’re probably dehydrated. Since the amount of water every person needs varies, talk to your doctor if you’re concerned about getting enough. “If you feel dehydrated or light-headed despite drinking fluids, you should call your doctor immediately,” says Parian. Keep in mind, water isn’t the only way to stay hydrated: A warm cup of chicken noodle soup feels comforting when you’re sick. In addition to staying hydrated, eat as healthfully as possible, rest, and follow up closely with your primary doctor.
7. You might experience a Crohn’s flare.
An infection like the flu can sometimes trigger a Crohn’s flare, and certain medications can lead to diarrhea. That’s why it’s so important to keep in touch with your GI doctor to help you manage your GI symptoms if you’re sick. “It’s not uncommon for many infections, including the flu, to have GI symptoms such as nausea and diarrhea that are not related to the underlying Crohn’s at all,” says Parian. “Your doctor may want to order some additional testing to determine if it’s a Crohn’s flare or not.”
