Disease Flares Due to COVID-19 Vaccines Manageable With Proper Care

In some cases, vaccines for COVID-19 can lead to a disease flare in people with cold agglutinin disease (CAD) and related conditions, but these flares can be readily managed with proper treatment, according to an Italian study.

These findings point to a need for close monitoring when these patients get vaccinated, and also demonstrate that “the benefits of vaccination greatly outweigh the risks,” according to its authors.

The study, “SARS-CoV-2 vaccination in patients with autoimmune cytopenias: the experience of a reference center,” was published in the American Journal of Hematology.

CAD is a type of autoimmune cytopenia — a broad group of conditions where the body’s own immune system attacks healthy blood cells. In these diseases, flares are often caused by triggers such as infections or surgery, which can send the immune system into overdrive.

Since vaccines work by activating the immune system, they may induce flares of these diseases. There have been some reports of people with CAD or similar diseases who experience a worsening of symptoms after getting vaccinated for COVID-19. However, there are not evidence-based guidelines for how best to manage vaccines in this patient population.

Researchers in Italy have now reported the outcomes of 108 people with autoimmune cytopenias, including 15 with CAD, who were vaccinated against COVID-19 at their clinic earlier this year. Most of these patients got the vaccine made by Pfizer-BioNTech.

The week before and after each vaccine dose, each patient’s blood was collected and analyzed. All the patients continued on their standard treatments without interruption when they were vaccinated.

Among CAD patients, there was one notable disease flare: One week after getting the first dose of the Moderna vaccine, a 77-year-old man experienced a substantial reduction in hemoglobin levels, which dropped from 9.3 to 7.2 g/dL. Hemoglobin is the protein that red blood cells use to carry oxygen through the bloodstream.

The man was treated with inflammation-reducing steroids, as well as rituximab, and erythropoietin. His condition improved, and the second dose of the vaccine was administered without issue.

Similar reactions to vaccination were observed in other types of autoimmune cytopenias. In all cases, patients were successfully treated to manage these reactions.

“Most patients rapidly improved with steroids or adjustment of ongoing treatment,” the researchers wrote.

“Our data show that [COVID-19] vaccination may be associated with a clinically significant decrease of hematologic [blood-related] values in [autoimmune cytopenia] cases that were rapidly rescued by treatment adaptation,” the team concluded.

These results indicate that monitoring patients’ blood in the week before and after getting a vaccine is likely appropriate, the researchers said. They also noted that, if a person has a bad reaction to the first dose of a vaccine that requires multiple doses to be fully effective — like the Pfizer-BioNtech and Moderna vaccines — the decision of whether or not to administer subsequent doses needs to be made on a case-by-case basis.