COVID-19 infection and vaccination in patients with hereditary angioedema: a multicentric study
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Authors Information
1Department of Allergy and Clinical Immunology, Coimbra Hospital and University Centre, Coimbra, Portugal
2Unit of Allergy and Clinical Immunology, Leiria Hospital Centre, Leiria, Portugal
3Unit of Allergy and Clinical Immunology, Tondela-Viseu Hospital Centre, Viseu, Portugal
4Department of Allergy and Clinical Immunology, Castelo Branco Local Health Unit, Castelo Branco, Portugal
5Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
6Institute of Immunology, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
7ICBR, Coimbra Biomedical and Clinical Research Institute, University of Coimbra, Portugal
8Department of Immunoallergology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
History
Published: 03 May 2023
Accepted: 28 April 2023
Received: 04 January 2023
SUMMARY
Background. 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.