Travel in patients receiving TNF-alpha inhibitors

The TNF-alpha inhibitors, infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira) are increasingly being used for chronic inflammatory diseases and have effectively allowed many patients to return to more active lifestyles. The impact of these agents on immune function has led to the recognition of specific infectious complications. The combination of the increasingly active lifestyles of those receiving these agents and their immunosuppressive effects pose new challenges for practitioners of travel medicine. The purpose of this article is to review the immunologic and infectious consequences of these therapies and their potential impact on travelers.