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SARS-CoV-2 vaccine response in patients with predominant antibody deficiency

Published: April 2, 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with predominant antibody deficiency (PAD), such as common variable immunodeficiency (CVID) and hypogammaglobulinemia, is associated with a high risk of serious infection. To date, there is limited data regarding the response to SARS-CoV-2 immunization in these patients.

In a recent article in The Journal of Allergy and Clinical Immunology: In Practice, Barmettler et al. examined antibody responses to SARS-CoV-2 vaccine in patients with predominant antibody deficiency compared to matched healthy controls. They assessed the levels and function of anti-SARS-CoV-2 antibodies in 62 PAD patients compared with matched healthy controls at baseline, at 4 to 6 weeks after the initial series of immunization (a single dose of Ad26.COV2.S [Janssen] or two doses of BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]), and at 4 to 6 weeks after an additional dose immunization, if received.

Barmettler and colleagues reported that patients with predominant antibody deficiency (PAD) had lower antibody responses to SARS-CoV-2 vaccines compared to case-matched healthy controls. They identified that risk factors for a low antibody response included patients with secondary PAD (eg, receiving a B-cell depleting therapy such as rituximab) and those patients with severe primary PAD (eg, common variable immunodeficiency with autoinflammatory complications). Lab values that correlated with a low anti-spike antibody response included certain immune markers including low CD4+ T helper cells, low CD19+ total B cells, and low class-switched memory (CD27+IgD/M–) B cells. In the study, a subset of PAD patients received an additional dose immunization (for a total of three vaccine doses in most cases) and this increased mean anti-spike antibody levels close to the level of the healthy controls after two doses. Given the high risk of serious infection and death from COVID-19 infection in this population, booster vaccination should be considered in addition to maintaining precautions regarding COVID-19 infection.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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