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Travel tip during the pandemic with Azathioprine

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Ulcerative Colitis
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Posted 11/15/2020 10:01 PM (GMT -7)
Hi folks,

There is a necessary(Can't avoid) international travel that i need to do in the coming few weeks. I am 27 years old(male) and have been on Azathioprine/Mesalamine for a while now. Azathioprine occasionally makes me very nauseous and then i take a short break(a week max) from it and resume again.

My WBC fluctuates b/w 3.5-4.5 which is borderline okayish afaik. I was thinking of stopping the azathioprine 3-4 days prior to the trip and then resume few days after reaching the destination. I plan to increase VitD from 5k to 10k as well.
Does that plan make sense? Any pointers would be highly appreciated.
Posted 11/15/2020 10:04 PM (GMT -7)
International...you will have to self-isolate, correct?
q
Posted 11/16/2020 1:39 AM (GMT -7)
Yes. Once i reach the destination, I will be staying alone for ~2 weeks and then take a covid test before getting to the stuff that i need to do.
Posted 11/16/2020 6:13 PM (GMT 0)
I don't know what you mean by can't avoid. I personally wouldn't travel on a plane during a major surge of COVID in US and elsewhere while on an immunosuppressant unless you are in a life-death situation (not a work or family obligation). All the experts and guidelines i've seen emphasize not traveling if you are in an immunocompromised state right now. All my healthy friends are avoiding plane travel too even the ones who have sick relatives in other locations :-(. We are averaging 150-180k new cases a day in US alone.

If you are in that type of extreme situation, then you can wear two masks (n-95 is best), face protection and defer to the CDC guidelines about what they recommend for travel. I would also contact the airline or let them staff know that you are on an immunosuppressant so they can seat you in an empty row at least.
Posted 11/17/2020 6:57 PM (GMT -7)
Stopping azathiopurine for a few days doesn't have an affect. Rather, an aza pill you take today has an impact about 6-8 weeks in the future.

Taking aza doesn't make you more likely to get sick. It does make your immune response weaker, if you do contract an illness, so symptoms would hit faster, be more severe, and you'd take longer to recover. Having slightly low WBC on Aza is normal, just don't want to be dangerously low (WBCs in the 1's or 2's).

A couple weeks back, I travelled on a domestic flight and did fine with reasonable precautions. Went through the Boston and Atlanta airports to my final destination what ended up being a covid19 hotspot (wasn't when I booked >_>). It was a family thing and unavoidable. I was of course worried, but cautious. Wore a mask, social distanced, didn't touch railings/door knobs when possible, avoided touching my face, strict about hand washing, etc. The airline had an empty seat between passengers. Boston was pretty empty, all flights on time.

So, it isn't necessarily a death-sentence assuming your cautious and not recklessly caviler about it. Not that I'd recommend travel for fun during a pandemic, obviously not my or your case.
Posted 11/18/2020 11:33 AM (GMT -7)
Thanks a lot for the tips iPoop and Jane974. Very helpful smile. Also, iPoop i think Azathioprine mechanism is a little weird. My WBC usually goes up in around a week once i stop my Aza. For UC , i think it takes 6-7 weeks to initially work. Once it starts working, even if you stop for a week, you can still get the therapeutic affect shortly after resuming it(I guess the Aza momentum lasts for a few weeks). These are just my personal experiences.

Do you know what Aza does to B-cell and T-cell? I heard some doc say that they are the ones that are important for fighting viral infections initially and not WBC
Posted 11/18/2020 7:24 PM (GMT -7)
Aza pills have no impact on WBC currently within your blood, rather it slows new WBC production within your bone marrow. Your body regularly clears WBC from your blood and then releases replacements every 6-8 weeks on average. Only then does it matter (slower production of wbc equals a lower total over time). Thus the slowness of that med.

I just know it's lymphocytes/wbc, not specifically B or T. I don't think it's selective, but more broad than narrow in effect.

Aza can affect RBC, platelet, etc production if it works too well (or is too high a dose).

My WBC swings around some over the years but not a lot.
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