"Abstract
Objective: The worldwide coronavirus disease 2019 (COVID-19) vaccination campaign triggered several autoimmune diseases. We hereby aimed to describe IgA vasculitis (IgAV) following COVID-19 vaccination...
Introduction
IgA vasculitis (IgAV) is an immune complex vasculitis that mainly affects the small vessels. Initial disease presentation is more severe in adults, with short-term prognosis affected mainly by gastrointestinal involvement, while kidney damage affects long-term morbidity and mortality IgAV usually occurs after an infection of the respiratory or digestive mucosa but can also be induced by a vaccine...
After the coronavirus disease 2019 (COVID-19) pandemic outbreak, a worldwide vaccination campaign was undertaken, using mainly a new mRNA-based technology. Several autoimmune manifestations following COVID-19 vaccination have been reported, such as thrombotic thrombocytopenia, Guillain Barré syndrome, and myocarditis. A few cases of vasculitis have also been reported, most being antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis, or IgAV.
Here, we aimed to report the first case series of IgAV associated with COVID-19 vaccination to study the patients’ baseline presentations and outcomes.
Methods
This national, multicenter, retrospective study included observations of adult IgAV following COVID-19 vaccination between January 1, 2020, and January 1, 2022, in France...
Results
In total, 12 patients were included from 12 centers... The median age was 52.5 (IQR 30.75-60.5) years...
Discussion
... In all patients, the most frequently administered vaccine was an mRNA vaccine (BNT162b2)... [M]ost cases of IgAV were triggered following the first dose of vaccine in our cohort (66.6%), which is in agreement with the literature (53%). Nonetheless, relapses of de novo IgAV following COVID-19 vaccination after a new vaccine dose (eg, the second or the third dose) may also occur...
Several hypotheses have been put forward to explain the occurrence of autoimmune disease following COVID-19 vaccination. Interestingly, regarding the occurrence of IgAV, it has been shown that in addition to IgG production after COVID-19 vaccination, IgA production occurs following the BNT162b2 and ChAdOx1 vaccines. To be more precise, an IgA serum peak is observed 11 days after the first vaccine injection and 7 days following the second injection. As SARS-CoV-2 enters its host through the pulmonary tract, it is essential to have an enhanced first-line IgA defense at this site to achieve better vaccine efficacy. Hypoglycosylated IgA plays a pivotal role during the onset of IgAV. It forms immune complexes, which further activate the immune system. Hence, we hypothesize that vaccination in these patients induced an IgA-mediated response, probably in hosts with a Ig-glycosylation enzyme deficiency."
Interpretative article:
IgA Vasculitis after COVID-19 Vaccination, by Peter McCullough
https://www.thefocalpoints.com/p/iga-vasculitis-after-covid-19-vaccination
© 2023 The Journal of Rheumatology. This is an Open Access article, which permits use, distribution, and reproduction, without modification, provided the original article is correctly cited and is not used for commercial purposes.