Maronese Carlo Alberto, Caproni Marzia, Moltrasio Chiara, Genovese Giovanni, Vezzoli Pamela, Sena Paolo, Previtali Giulia, Cozzani Emanuele, Gasparini Giulia, Parodi Aurora, Atzori Laura, Antiga Emiliano, Maglie Roberto, Moro Francesco, Mariotti Elena Biancamaria, Corrà Alberto, Pallotta Sabatino, Didona Biagio, Marzano Angelo Valerio, Di Zenzo Giovanni
Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Front Med (Lausanne). 2022 Feb 28;9:841506. doi: 10.3389/fmed.2022.841506. eCollection 2022.
Bullous pemphigoid (BP) is an autoimmune bullous disease caused by circulating autoantibodies toward the hemidesmosomal antigens BP180 and BP230. Cases of BP have been described following vaccinations against tetanus, poliomyelitis, diphtheria, influenza, pneumococcus, meningococcus, hepatitis B and rabies. The putative mechanism by which COVID-19-vaccines may induce BP has not been clarified. An Italian multicentre study was conducted to collect clinical, histopathological and immunopathological data of patients with BP associated with COVID-19-vaccines. Twenty-one cases were collected, including 9 females and 12 males (M/F = 1.3) with a median age at diagnosis of 82 years. Seventeen patients received the COMIRNATY Pfizer-BioNTech vaccine, two the Moderna mRNA-1273 vaccine, one the ChAdOx1/nCoV-19-AstraZeneca/ Vaxzevria vaccine and one received the first dose with the ChAdOx1/nCoV-19-AstraZeneca/Vaxzevria vaccine and the second dose with the COMIRNATY Pfizer-BioNTech vaccine. Median latency time between the first dose of anti-SARS-CoV-2 vaccine and the onset of cutaneous manifestations was 27 days. Median BPDAI at onset was 42. Eleven out of seventeen patients (65%) had positive titres for anti-BP180 antibodies with a median value of 106.3 U/mL on ELISA; in contrast, only five out of seventeen (29%) were positive for anti-BP230 antibodies, with a median of 35.3 U/mL. In conclusion, in terms of mean age, disease severity at diagnosis and clinical phenotype vaccine-associated BP patients seem to be similar to idiopathic BP with an overall benign course with appropriate treatment. On the other hand, the slight male predominance and the reduced humoral response to BP230 represent peculiar features of this subset of patients.
大疱性类天疱疮（BP）是一种自身免疫性大疱性疾病，由针对半桥粒抗原BP180和BP230的循环自身抗体引起。在接种破伤风、脊髓灰质炎、白喉、流感、肺炎球菌、脑膜炎球菌、乙型肝炎和狂犬病疫苗后，曾有BP病例的报道。新冠病毒疫苗可能诱发BP的推定机制尚未阐明。一项意大利多中心研究收集了与新冠病毒疫苗相关的BP患者的临床、组织病理学和免疫病理学数据。共收集了21例病例，其中包括9名女性和12名男性（男/女 = 1.3），诊断时的中位年龄为82岁。17名患者接种了辉瑞 - 生物科技公司的COMIRNATY疫苗，2名接种了莫德纳mRNA - 1273疫苗，1名接种了牛津/新冠病毒 - 19 - 阿斯利康/瓦克斯瑞亚疫苗，1名接种了第一剂牛津/新冠病毒 - 19 - 阿斯利康/瓦克斯瑞亚疫苗，第二剂接种了辉瑞 - 生物科技公司的COMIRNATY疫苗。第一剂抗SARS-CoV-2疫苗与皮肤表现出现之间的中位潜伏期为27天。发病时的中位BPDAI为42。17名患者中有11名（65%）抗BP180抗体滴度呈阳性，ELISA检测的中位值为106.3 U/mL；相比之下，17名患者中只有5名（29%）抗BP230抗体呈阳性，中位值为35.3 U/mL。总之，就平均年龄、诊断时的疾病严重程度和临床表型而言，疫苗相关的BP患者似乎与特发性BP相似，经过适当治疗，总体病程呈良性。另一方面，男性略占优势以及对BP230的体液反应降低是这部分患者的独特特征。
