Background
Patients with primary antibody deficiencies, such as
Common Variable Immunodeficiency (CVID), have some problems to assess
immune response after
coronavirus disease (COVID)
vaccination. Cutaneous delayed-type
hypersensitivity (DTH) has the potential to be used as a useful, simple, and cheaper tool to assess
T-cell (
T lymphocyte) function.
Methods Seventeen
patients with CVID, a
rare disease, received two doses of the
mRNA-based Pfizer-BioNTech
COVID-19 vaccine.
Humoral Immune Response (HIR) was determined by measuring specific
immunoglobulin G (
IgG)
antibodies, and
Cellular Immune Response (CIR) was evaluated using an ex vivo
interferon-gamma release assay (IGRA) and in vivo by DTH
skin test.Results Two weeks after the second
dose of the
vaccine, 12 out of 17 CVID
patients have high optical density (OD) ratios of specific anti-spike
protein (S)
IgG whereas five
patients were negative or low. Ex vivo CIR was considered positive in 14 out of 17 S1-stimulated
patients. Unspecific stimulation was positive in all 17
patients showing no
T-cell defect. A positive DTH
skin test was observed in 16 CVID
patients. The only
patient with negative DTH also had negative ex vivo CIR.Conclusions The use of DTH to evaluate CIR was validated with an optimal correlation with the ex vivo CIR. The CIR after
vaccination in
patients with antibody deficiencies seems to have high precision and more
sensitivity to
antibodies-based
methods in CVID.Clinical Implications There is a remarkable correlation between cutaneous DTH and ex vivo IGRA after COVID
vaccination. A COVID-specific
skin DTH test could be implemented in large
populations.
Capsule Summary Cutaneous delayed-type
hypersensitivity has the potential to be used as a useful, simple, and cheaper tool to assess
T-cell functioning (AU)