COVID-19 infection and vaccination in patients with hereditary angioedema: multicentric study
Inês Filipa da Costa Farinha firstname.lastname@example.org
, Maria Beatriz Gaspar de Paiva Neto Freitas Tavares1
, Nuno Alexandre Gaspar de Sousa2
, Eugénia Matos Marques Almeida3
, Carlos Lozoya Ibáñez4,5
, Frederico Eugénio de Castro Soares Regateiro1,6,7
, Ana Maria Pego Todo-Bom Ferreira da Costa1,8
, Emília Maria Antunes Gomes de Faria1Show more: Authors information and Publication history
Department of Allergy and Clinical Immunology, Coimbra Hospital and University Centre, Coimbra, Portugal2
Unit of Allergy and Clinical Immunology, Leiria Hospital Centre, Leiria, Portugal3
Unit of Allergy and Clinical Immunology, Tondela-Viseu Hospital Centre, Viseu, Portugal4
Department of Allergy and Clinical Immunology, Castelo Branco Local Health Unit, Castelo Branco, Portugal5
Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal6
Institute of Immunology, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal7
Coimbra Biomedical and Clinical Research Institute (ICBR), University of Coimbra, Portugal8
Department of Immunoallergology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Published: 03 May 2023
Accepted: 28 April 2023
Received: 04 January 2023
Due to similarities between the pathophysiological mechanisms of hereditary angioedema (HAE) and COVID-19, it has been hypothesized that SARS-CoV-2 infection may trigger HAE attacks or, alternatively, that HAE patients may experience different of COVID-19 disease severity. Furthermore, the potential for COVID-19 vaccination to trigger angioedema attacks in patients with HAE is still not completely defined.The objective is to characterize the exacerbations and clinical manifestations associated with COVID-19 infection and describe the adverse effects of COVID-19 vaccination in patients with HAE. Methods.
Retrospective observational, descriptive, non-interventional, multicenter study conducted in four Allergy Units and Departments in Central Portugal between March 2020 and July 2022. HAE patient data were obtained from electronic medical records. Results.
The study included 34 patients (67.6% female): 26 with HAE type 1, 5 with HAE type 2, and 3 with HAE with normal C1 inhibitor. Most patients with HAE type 1 and 2 were receiving long-term prophylaxis. Among the 32 patients who received COVID-19 vaccination, 86 doses, were administered with one angioedema attack (1.2%) associated with vaccination. A small increase in the average number of attacks was observed in the year following COVID vaccination (7.1 versus
6.2 in the previous year, p = 0.029), however, this difference is unlikely to be clinically significant, as the context of the COVID-19 pandemic likely introduced numerous confounders. During the study period, 16 HAE patients had COVID-19, all presenting with mild disease. Four out of 16 patients (25%) reported angioedema attacks during COVID-19, and 43.8% during the convalescence period (3 months after infection). Conclusions.
Patients with HAE can safely receive COVID-19 vaccination. The severity of COVID-19 infection does not appear to be increased in HAE patients.
Key words FULL TEXT
COVID-19; hereditary angioedema; prophylaxis; SARS-CoV-2; vaccination.