A 21-year-old woman with asthma has an active systemic infection requiring urgent referral. Which medicine should be avoided?

• A. Salmeterol
• B. Montelukast
• C. Fluticasone
• D. Influenza vaccine

Answer: (D)

Vaccination is typically postponed during a significant acute systemic illness because the immune system is already engaged fighting the infection. Giving a vaccine at this time can blunt the immune response to the vaccine and potentially worsen symptoms or cause confusion with the illness itself. For that reason, an influenza vaccine should be avoided when there is an active systemic infection requiring urgent referral, and vaccination is delayed until recovery.

The other asthma medications do not carry the same contraindication in the setting of an acute infection. Maintaining inhaled corticosteroids and bronchodilators helps keep asthma under control, while montelukast continues to reduce leukotriene-driven inflammation. They are not routinely withheld during an acute illness unless there are other specific contraindications. The key point is that the infection takes priority for treatment now, and vaccination is deferred until the patient is well.