German Society for Angioedema Research |
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German Society for Angioedema Research |
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1. No major experience has yet been gained on how COVID-19 disease affects patients with hereditary angioedema (HAE).
2. As far as can be estimated today, the risk of developing COVID-19 is no different in HAE patients than in other people. More generally, the disease mechanism of C1-INH deficiency with and without symptoms also does not support an increased risk for infectious disease.
3. As known from other acute infectious diseases, an acute COVID-19 infection could also trigger an acute swelling attack in HAE patients. However, nothing more specific has been reported about this to date. That being said, based on the data compiled to date, we do not expect a COVID-19 infection to have a significant impact on the course of HAE, or HAE on the course of COVID-19 disease.
4. Drug treatment of HAE is not immunosuppressive therapy (cortisone is not effective and should not be used!). In this respect, drug treatment of HAE does not appear to be associated with an increased risk of COVID-19 disease.
5. Based on experience compiled to date, the risk of having a swelling attack from COVID-19 vaccination is considered to be low. Attention should be paid to the recommendation of the “Hereditary angioedema due to C1 inhibitor deficiency” guideline issued by the AWMF (Association of the Scientific Medical Societies in Germany), which states that HAE patients generally carry with them medication to treat at least 2 episodes of swelling (see also Section II).
6. Intubation and extubation can cause laryngeal edema in patients with HAE due to C1-INH deficiency. This is a rare occurrence and applies to all intubations and extubations, with or without association with COVID-19.
The database on the tolerability and efficacy of COVID-19 vaccines in HAE patients is currently very limited.
Based on current data, HAE is not a risk factor that argues against COVID-19 vaccination.
In principle, there is a possibility that vaccination can also trigger an HAE attack. Therefore, the general recommendations of the German guideline for Hereditary Angioedema due to C1 Inhibitor Deficiency apply here, namely that every patient should have the medication in stock at home for treating at least two attacks and carry it with them when traveling.
Of course, other risk factors independent of HAE should also be considered in HAE patients. For those with a history of anaphylactic reactions, the risk of a serious side effect due to vaccination (independent of HAE) should be weighed particularly carefully against the expected benefit.
The database on the tolerability and efficacy of COVID-19 vaccines is growing rapidly. The continuous increase in knowledge can lead to short-term modifications of current recommendations.
Mainz, April 12, 2021
German Society for Angioedema Research
Prof. Dr. Konrad Bork,
Dr. Inmaculada Martinez-Saguer
Prof. Dr. Petra Staubach-Renz
