COVID-19 and hereditary angioedema: Incidence, outcomes, and mechanistic implications.
Allergy Asthma Proc
; 42(6): 506-514, 2021 Nov 01.
Article
in English
| MEDLINE | ID: covidwho-1533595
ABSTRACT
Background:
Patients with hereditary angioedema (HAE) have been postulated to be at increased risk for coronavirus disease 2019 (COVID-19) infection due to inherent dysregulation of the plasma kallikrein-kinin system. Only limited data have been available to explore this hypothesis.Objective:
To assess the interrelationship(s) between COVID-19 and HAE.Methods:
Self-reported COVID-19 infection, complications, morbidity, and mortality were surveyed by using an online questionnaire. The participants included subjects with HAE with C1 inhibitor (C1INH) deficiency (HAE-C1INH) and subjects with HAE with normal C1-inhibitor (HAE-nl-C1INH), and household controls (normal controls). The impact of HAE medications was examined.Results:
A total of 1162 participants who completed the survey were analyzed, including 695 subjects with HAE-C1INH, 175 subjects with HAE-nl-C1INH, and 292 normal controls. The incidence of reported COVID-19 was not significantly different between the normal controls (9%) and the subjects with HAE-C1INH (11%) but was greater in the subjects with HAE-nl-C1INH (19%; p = 0.006). Obesity was positively correlated with COVID-19 across the overall population (p = 0.012), with a similar but nonsignificant trend in the subjects with HAE-C1INH. Comorbid autoimmune disease was a risk factor for COVID-19 in the subjects with HAE-C1INH (p = 0.047). COVID-19 severity and complications were similar in all the groups. Reported COVID-19 was reduced in the subjects with HAE-C1INH who received prophylactic subcutaneous C1INH (5.6%; p = 0.0371) or on-demand icatibant (7.8%; p = 0.0016). The subjects with HAE-C1INH and not on any HAE medications had an increased risk of COVID-19 compared with the normal controls (24.5%; p = 0.006).Conclusion:
The subjects with HAE-C1INH who were not taking HAE medications had a significantly higher rate of reported COVID-19 infection. Subcutaneous C1INH and icatibant use were associated with a significantly reduced rate of reported COVID-19. The results implicated potential roles for the complement cascade and tissue kallikrein-kinin pathways in the pathogenesis of COVID-19 in patients with HAE-C1INH.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Bradykinin
/
Complement C1 Inactivator Proteins
/
Complement C1 Inhibitor Protein
/
Angioedemas, Hereditary
/
Hereditary Angioedema Types I and II
/
COVID-19
/
Angioedema
Type of study:
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Allergy Asthma Proc
Journal subject:
Allergy and Immunology
Year:
2021
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS