COVID ‐19 vaccine acceptance and hesitancy in patients with immunobullous diseases: a cross‐sectional study of the International Pemphigus and Pemphigoid Foundation

Association between vaccination and immunobullous disorders: a brief, updated systematic review with focus on COVID‐19

“…These comprised 27 case reports/series ( n = 272 vaccine recipients; 218 [80.1%] unspecified AIBDs, 41 [15.1%] bullous pemphigoid, 10 [3.7%] pemphigus vulgaris, 2 [0.7%] linear IgA disease and 1 [0.4%] pemphigus foliaceus), one prospective observational case–control study ( n = 8 vaccine recipients; 8 [100%] unspecified pemphigus subtype), one registry‐based study ( n = 12 vaccine recipients; 12 [100%] bullous pemphigoid) and one cross‐sectional study ( n = 640 vaccine recipients; 640 [100%] unspecified AIBDs). 4 Among the 932 immunized individuals, patients either presented clinically with de novo AIBDs ( n = 53; 5.7%) or had a flare/worsening of pre‐existing AIBDs ( n = 91; 9.7%) after vaccination, whereas vaccination did not negatively influence the clinical course in 788 (84.5%) patients. The COVID‐19 vaccines used were mRNA vaccines (Pfizer‐BioNTech or Moderna; n = 756, 81.1%), adenoviral vector vaccines (AstraZeneca or Johnson & Johnson; n = 144, 15.5%), and inactivated vaccines (Sinovac/CoronaVac or Sinopharm; n = 17, 1.8%), whereas information about the vaccine type was not available in 18 (1.9%) patients.…”

“…Whether this represents a bona fide causal relationship or is pure coincidence, however, is unknown, taking into account that the information is mainly derived from single case reports/series with a low level of evidence and a cross‐sectional study biased by subjective patient self‐reports. 4 In addition, the lack of cross‐reactivity between circulating anti‐SARS‐CoV‐2 antibodies and pemphigus or pemphigoid autoantigens argues against immunization‐driven autoimmunity from a mechanistic perspective, 5 although alternative immunocellular modalities potentially promoting autoimmune processes by COVID‐19 vaccines cannot be excluded.…”

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

“…Currently, the SARS-CoV-2 vaccines are widely administered to prevent deaths due to COVID-19 infection and to end the pandemic. However, it is reported that only 68% of patients with autoimmune bullous diseases would accept the COVID-19 vaccination without hesitancy or denial, while others showed their concerns of whether the vaccine would induce disease exacerbation or relapse [ 42 ]. In contrast, EULAR recommended that live-attenuated vaccines may be considered with caution in patients with rheumatic diseases [ 43 ].…”

Association between COVID‐19 vaccination and autoimmune bullous diseases: a random coincidence or rare event

“… 2 Likewise, the validity of supposed induction or triggering of AIBDs by COVID‐19 vaccines is limited, taking into account that the summarized data are generally based on single case reports with a low level of evidence and a cross‐sectional study biased by subjective patient self‐reports. 2 , 3 In addition, our previous investigation with healthy individuals who received the mRNA COVID‐19 vaccine revealed that circulating anti‐SARS‐CoV‐2 antibodies do not cross‐react with pemphigus or pemphigoid autoantigens including desmoglein 1, desmoglein 3, envoplakin, BP180, BP230 and type VII collagen. 4 This argues against a link between SARS‐CoV‐2 vaccines and AIBDs with respect to disease‐triggering antibody cross‐reactivity.…”

“…This is of particular relevance in terms of patient counselling and physician endorsement, considering that SARS‐CoV‐2 vaccine hesitancy is prevalent across the AIBD population (approximately one third), with concern regarding immunobullous exacerbation representing a major factor contributing to hesitancy. 3 …”