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- Page navigation anchor for RE: Systemic Capillary Leak Syndrome, SARS-CoV-2 infection and COVID19 vaccines: caught between two firesRE: Systemic Capillary Leak Syndrome, SARS-CoV-2 infection and COVID19 vaccines: caught between two fires
We read with great interest the article from Robichaud et al. SARS-CoV-2 has been shown to induce Systemic Capillary Leak Syndrome (SCLS, Clarkson’s Disease) recurrence (2-3) and vaccination is needed in these patients: reporting of acute flares following vaccination raises an additional problem. Prophylaxis with intravenous immunoglobulins (IVIg) improves survival (4), reducing the frequency and severity of recurrence. We share the author’s opinion on the need for IgIV infusion before COVID-19 vaccination. To minimize the risk, vaccine could be administrated immediately following IVIg perfusion, to maximize their preventive effect. However, concomitant vaccination and IVIg infusion are usually not advised for several reasons. First, in case of adverse events, it could be difficult to determine the cause. Second, specific antibodies contained in IVIg preparations and directed against constituent of the vaccine could reduce its immunogenicity. This is relevant to live attenuated vaccines, for which an interval of several months is recommended between vaccine and IgIV(5), and seems to apply to viral vector rather than mRNA vaccines. Last, the immunomodulatory effect of IVIg might impair the response to the antigenic stimulus, reducing the effectiveness of vaccination. Albeit, there are no advice on spacing out IVIg infusion and inactivated or protein vaccines. Moreover, according to the U.S. Center for Disease Control, there is no recommendation on a minimal interval between...
Show MoreCompeting Interests: None declared.References
- Julie Robichaud, Catherine Côté, Fanny Côté. Systemic capillary leak syndrome after ChAdOx1 nCOV-19 (Oxford–AstraZeneca) vaccination. CMAJ 2021;193:E1341-E1344.
- Pineton de Chambrun M, Cohen-Aubart F, Donker DW, et al. SARS.CoV-2 induces acute and refractory relapse of systemic capillary Leak Syndrome (Clarkson’s Disease). Am J Med 2020 Nov;133(11):e663-e664. doi: 10.1016/j.amjmed.2020.03.057.
- Case R, Ramaniuk A, Martin P, et al. Systemic capillary leak syndrome secondary to coronavirus disease 2019. Chest 2020; 158(6):e267-e268. doi: 10.1016/j.chest.2020.06.049.
- Pineton de Chambrun M, Goussef M, Mauhin W, et al. Intravenous immunoglobulins improve survival in monoclonal gammopathy-associated systemic capillary-leak syndrome. Am J Med 2017 Oct;130(10):1219.e19-1219.e27. doi: 10.1016/j.amjmed.2017.05.023
- Public Health Agency of Canada. Canadian Immunization Guide: Part 1 – Key Immunization Information – Blood Products, human immunoglobulin and timing of immunization. Last complete chapter revision: December 2013. Available at https://www.canada.ca/en/publ