Messenger RNA vaccines and neutralizing anti–severe acute respiratory syndrome coronavirus 2 antibodies in patients with immunodeficiency

Abstract

We would like to share our ideas on the article entitled “Detection of neutralizing anti–severe acute respiratory syndrome coronavirus 2 antibodies in patients with common variable immunodeficiency after immunization with messenger RNA vaccines.”1Romano C, Esposito S, Donnarumma G, Marrone A. Detection of neutralizing anti-severe acute respiratory syndrome coronavirus 2 antibodies in patients with common variable immunodeficiency after immunization with mRNA vaccines. Ann Allergy Asthma Immunol. 2021; 127(4): 499-501.Google Scholar Romano et al1Romano C, Esposito S, Donnarumma G, Marrone A. Detection of neutralizing anti-severe acute respiratory syndrome coronavirus 2 antibodies in patients with common variable immunodeficiency after immunization with mRNA vaccines. Ann Allergy Asthma Immunol. 2021; 127(4): 499-501.Google Scholar concluded that “CVID patients must be included in COVID-19 vaccination programs because of the ability of mRNA vaccines to safely induce production of neutralizing antibodies in this category of patients.” Given that Romano et al1Romano C, Esposito S, Donnarumma G, Marrone A. Detection of neutralizing anti-severe acute respiratory syndrome coronavirus 2 antibodies in patients with common variable immunodeficiency after immunization with mRNA vaccines. Ann Allergy Asthma Immunol. 2021; 127(4): 499-501.Google Scholar noted that the production of neutralizing antibodies did not mean protection, it is, therefore, necessary to have further studies for confirmation on the advantage of vaccines. Whether the messenger RNA (mRNA) can result in unwanted immunologic problems in a common variable immunodeficiency (CVID) case is also another important question. An association between CVID and autoimmunity was proposed.2Agarwal S Rundles CC. Autoimmunity in common variable immunodeficiency.Ann Allergy Asthma Immunol. 2019; 123: 454-460Abstract Full Text Full Text PDF Scopus (36) Google Scholar,3Brandt D Gershwin ME. Common variable immune deficiency and autoimmunity.Autoimmun Rev. 2006; 5: 465-470Crossref PubMed Scopus (113) Google Scholar There are many reports on the possible association between mRNA COVID-19 vaccine and autoimmunity generation.4Talotta R. Do COVID-19 RNA-based vaccines put at risk of immune-mediated diseases? In reply to “potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases.Clin Immunol. 2021; 224108665Crossref PubMed Scopus (101) Google Scholar A careful risk and benefit evaluation is needed for making any recommendation on using the mRNA COVID-19 vaccine among CVID cases. Authors’ responseAnnals of Allergy, Asthma & ImmunologyVol. 127Issue 6PreviewWe understand the concerns expressed by Drs Mungmunpuntipantip and Wiwanitkit regarding the efficacy and safety of messenger (m)RNA vaccines in patients with common variable immunodeficiency (CVID); however, we still strongly stick to the conclusions expressed in our report.1 With regard to efficacy, the aim of our study was to evaluate whether patients with CVID could generate neutralizing antibodies against severe acute respiratory syndrome coronavirus 2, and all but 1 actually did.1 Clearly, as already mentioned in the article, evaluation of the clinical significance of these antibodies (ie, protection against severe manifestations of coronavirus disease 2019 [COVID-19] and death) requires further studies. Full-Text PDF