ABSTRACT
Background: Hereditary (HAE-C1- INH) and acquired (AAE C1-INH) angioedema with C1 inhibitor (C1 INH) deficiency are rare but potentially life-threatening conditions associated with bradykinin overproduction and recurrent episodes of angioedema without wheals. Increased susceptibility to infections or infection-associated fatal outcomes has not been previously described in this condition. However, in 2020 novel theories suggesting bradykinin as a potential mediator involved in lung injury in COVID-19 disease have been proposed. Therefore, a more severe course of COVID-19 infection in C1 INH deficient should be considered. Method(s): In September 2021, we performed a retrospective analysis of COVID-19 disease courses in HAE C1-INH and AAE C1-INH patients from Czech referral centers for the treatment of hereditary angioedema with C1 INH deficiency. Collected data involved basic demography, comorbidities, previous immunosuppressive treatment, COVID-19 symptoms and treatment, HAE symptoms during infection. Result(s): We identified 17 patients (10 females, 7 males) with C1 INH deficiency with COVID-19 positivity from March 2020 until September 2021 with median age of 45 years (10-80 years). Our cohort consisted of 16 HAE C1-INH patients (94%, HAE-1 15/ 16 -94%, HAE-2 1/16 -6%) and 1 AAE C1-INH patient (6%). Only 8 (47%) of the patients were receiving HAE prophylaxis. Most common comorbidity was obesity (4/17, 24%) followed by autoimmune disease (3/17, 18%), hypertension (3/17, 18%), immunodeficiency (3/ 17, 18%), prior immunosuppressive treatment (3/ 17, 18%) and malignancy (2/17, 12%). COVID-19 infection was asymptomatic in 3 of them (18%). Symptomatic patients reported most commonly fever (10/14, 67%), anosmia and ageusia (8/14, 53%) and headache (3/14, 20%). Only 2 symptomatic patients (14%) had pneumonia treated with antibiotics. None of our patients were treated with monoclonal antibodies or referred to the hospital. All the patients recovered. Two patients reported long-lasting symptoms more than 3 months after infection. Five patients (29%) experienced HAE attacks and in two of them, increased attack frequency lasted several weeks after recovery. Conclusion(s): According to our findings, we do not assume C1 INH deficiency to be a risk factor for a severe course of COVID-19 disease. However, as other infections, COVID-19 might trigger angioedema attacks and may cause increased attack frequency after recovery.
ABSTRACT
SUMMARY Intradermal tests are important part of allergy testing in individuals with suspected hypersensitivity to vaccines or its compounds. According to previous findings, intradermal tests with Comirnaty vaccine causes delayed skin reaction considered to be a proof of existing cellular antiviral immunity. Our research confirmed delayed skin reactions after intradermal tests with Comirnaty not only in previously vaccinated individuals but also in not vaccinated volunteer. Therefore, we do not recommend using this test either for cellular immunity, evaluation or for delayed type of hypersensitivity assessment.
ABSTRACT
Some theories suggest, that bradykinin may play a role in pathogenesis of tissue damage in COVID-19 infection. It is also a main mediator responsible for angioedema attacks in patients with hereditary angioedema. Therefore we may assume COVID-19 infection can be more severe for these patients. Unfortunately we have only limited data about course of COVID-19 disease in hereditarian angioedema patients so far. However, angioedema without wheals has been described in patients with COVID-19 infection and some trials showed improvement of COVID-19 pneumonia after administration of drugs, commonly used for angioedema treatment. These findings may support bradykinin involvement in COVID-19 tissue damage.
ABSTRACT
The University Hospital in Prague – Motol conducted a seroprevalence study among its employees during the COVID-19 pandemic in the summer of 2020 and subsequently in 2021. While in 2020 positivity was found in only 2% of tested employees, in 2021 the situation changed significantly with the ongoing waves of infection and the initiation of vaccination programs. The presented study provides an overview of the current status of the immune response among hospital employees in September 2021. The data show a very significant vaccination rate among employees of the hospital that provides a very good and stable antibody response, especially robust in those who have had COVID-19 in addition to vaccination. The infection itself induces a diversified immune response against a wider range of viral antigens, but compared to vaccination, it is accompanied by a lack of detectable antibody levels several months after infection in a subset of vaccinees. Monitoring of adverse reactions after vaccination or acquired disease after vaccination yielded the expected results, confirming mainly the frequent occurrence of mild, mainly local reactions and the possibility of breaking vaccination protection in a small number of about 2% of vaccinated persons, presenting mostly as an asymptomatic or mild disease. The work also discusses the individual approach to a few individual employees who did not respond to basal vaccinations and whose situation was addressed, in some cases, by indications of further vaccination dose, with a favorable outcome. Overall, the situation among employees in terms of their immune response can be assessed as very favorable, reflecting the stage of the pandemic in autumn 2021.