Acute angioedena attacks after COVID-19 disease or COVID-19 vaccination in a population afflicted with hereditary angioedema

Background: Few studies demonstrating the involvement of the complement system in COVID-19 pathogenesis have been published, suggesting its role in pulmonary symptoms and endothelial permeability, which is known to be crucial in the origin of Hereditary Angioedema (HAE).1 Post-morten tissue of COVID-19 patients reported depots of complement, activated by the lectin pathway, in type I and II alveolar epithelial cells.2 After this evidence and the link that infectious processes have as triggers of angioedema episodes, in patients with HAE, we propose to study the implication of both the infection and de doses of the COVID vaccine, in the appearance of episodes of angioedema in our population with a diagnos is of HAE. Method(s): Telemedicine interventions (telephone consultations) were carried out by trained Allergists from Hospital Universitario de Canarias, reaching out patients with a confirmed diagnosis of HEA by Skin Allergy Unit (SAU) within the local health district. Result(s): A total of 17 (11 females) were finally screened, and 2 (11.76%) passed a confirmed COVID-19 disease in January 2022 associating no acute attacks or need for rescue medication. Both subjects were fully vaccinated (3 doses-schedule) prior to the infection and suffered from a COVID-19 mild disease only. Only an individual dose of COVID-19 vaccination (Vaxzevria, Astra-Zeneca) -out of 40 overall given doses in 15 subjects and 3 different brands-was associated to an acute episode of abdominal swelling demanding immediate self-administered rescue therapy (icatibant) thus, preventing the patient from rushing to the Emergency Department. The subsequent 2 doses of the COVID-19 vaccination were safely scheduled in the same patient. Conclusion(s): In accordance with former reports4, only mild COVID-19 symptoms were associated in subjects with a confirmed diagnosis of HAE.

Comorbidities and clinical severity of COVID-19: systematic review and meta-analysis

RESUMEN Introducción: La emergencia de la COVID-19 se ha convertido en un serio problema de salud a nivel mundial. La identificación de comorbilidades asociadas a la presentación clínica grave de la COVID-19, es de importancia para el adecuado abordaje terapéutico de los pacientes afectados. Objetivo: Evaluar el riesgo de COVID-19 con presentación clínica grave en pacientes con comorbilidades. Material y métodos: Se realizó una revisión sistemática y meta-análisis en bases de datos especializadas en busca de artículos publicados hasta el 20 de marzo de 2020, que aportaran información sobre la asociación entre la gravedad de la presentación clínica de la COVID-19 y comorbilidades. Se empleó la razón de probabilidades con un intervalo de confianza de 95 %, y modelos de efectos fijos o aleatorios. Resultados: En el análisis fueron incluidos 13 estudios para un total de 99 817 pacientes. Se obtuvieron los efectos globales para la hipertensión arterial (RP: 4,05;IC 95 %: 3,45-4,74), enfermedad cardiovascular (RP: 4,39;IC 95 %: 3,29-5,87), Diabetes Mellitus (RP: 3,53;IC 95 %: 2,79-4,47), hábito de fumar (RP: 2,87;IC 95 %: 1,81-4,54), enfermedades respiratoria (RP: 2,73;IC 95 %: 2,55-2,94), renal (RP: 5,60;IC 95 %: 4,13-7,60) y hepática crónicas (RP: 1,98 (IC 95 %: 1,08-3,64) e inmunodeficiencias (RP: 2,90;IC 95 %: 2,06-4,09), en pacientes graves en comparación con pacientes no graves. Conclusiones: La enfermedad renal crónica, la enfermedad cardiovascular, la hipertensión arterial y la Diabetes Mellitus están entre las comorbilidades que mayor riesgo implican para una presentación clínica grave en pacientes con COVID-19, seguidas en importancia por las inmunodeficiencias, hábito de fumar, enfermedad respiratoria crónica y enfermedad hepática crónica. ABSTRACT Introduction: The recent emergence of COVID-19 has become a serious global health problem. The identification of comorbidities associated with the clinical severity in COVID-19 patients is of paramount significance for the appropriate therapeutic approach of affected patients. Objective: To evaluate the risk of severe clinical presentation of COVID-19 in patients with comorbidities. Materials and methods: A systematic literature search and meta-analysis was conducted in specialized databases to obtain information from articles published until March 20, 2020. All relevant papers with information on the association between clinical severity and comorbidities were included. The odds ratio with 95 % confidence interval and fixed or random effect models were used. Results: Thirteen studies were included for a total of 99 817 patients. Global effects were obtained for hypertension (OR: 4.05;95 % CI: 3.45-4.74), cardiovascular disease (OR: 4.39;95 % CI: 3.29-5.87), diabetes mellitus (OR: 3.53;95 % CI: 2.79-4.47), smoking (OR: 2.87;95 % CI: 1.81-4.54), chronic lung disease (OR: 2.73;95 % CI: 2.55-2.94), chronic kidney disease (OR: 5.60;95 % CI: 4.13-7.60), chronic liver disease (OR: 1.98;95 % CI: 1.08-3.64), and immunodeficiency (OR: 2.90;95 % CI: 2.06-4.09) in severe patients compared with non-severe patients. Conclusions: Chronic kidney disease, cardiovascular disease, hypertension and diabetes are among the comorbidities with the highest risk of severe clinical presentation in COVID-19 patients, followed in importance by immunodeficiency, smoking, chronic lung disease and chronic liver disease.