Low IgG trough and lymphocyte subset counts are associated with hospitalization for COVID-19 in patients with primary antibody deficiency

Impact of SARS-CoV-2 infection and COVID-19 on patients with inborn errors of immunity

“… 43 , 58 , 89 , 91 , 92 , 94 , 95 , 98 , 103 , 105 , 106 , 108 , 111 , 112 , 115 Other predictors of severe disease in IEI patients included leukopenia (reduced numbers of B, CD4 + T, and natural killer cells) and hypogammaglobulinemia/low IgG trough levels before infection, and increased levels of markers of systemic inflammation after infection. 43 , 46 , 58 , 66 , 103 , 109 , 111 , 114 Interestingly, and similar to the general population, ∼10% to 20% of infected IEI patients were asymptomatic, and up to another ∼30% to 50% developed only mild disease. 15 , 89 , 90 , 92 , 93 , 94 , 95 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 …”

“… 43 , 46 , 58 , 66 , 103 , 109 , 111 , 114 Interestingly, and similar to the general population, ∼10% to 20% of infected IEI patients were asymptomatic, and up to another ∼30% to 50% developed only mild disease. 15 , 89 , 90 , 92 , 93 , 94 , 95 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 …”

COVID-19 and Inborn Errors of Immunity

“…In line with these findings in the study by Meyts et al ( 4 ), all adult patients that died of COVID19 ( n = 7) carried significant preexisting multiple organ impairment. By contrast, another multicenter study ( 9 ) did not confirm that increased age and body mass index have a negative impact on COVID-19 outcomes; nonetheless, this and other groups convincingly showed increased mortality in patients with low lymphocyte counts (T, B, and NK cells) and low levels of IgG, IgM, and IgA ( 9 , 57 , 69 ).…”

“…Different from the general population, age and metabolic comorbidities did not represent a risk factor for a severe course in this group of patients ( 70 ). Among the other causes of PAD, subjects with APDS ( n = 7) and IgA deficiency ( n = 17) had the best outcomes with no deaths or need for ICU care, while patients with NFKB2 deficiency had variable clinical severity ( 4 , 37 , 43 , 57 ).…”

“…Convalescent plasma appeared to be safe and effective in multiple patients with IEI; however, caution is required due to the presence of anti-type I interferon antibodies in the plasma preparations ( 25 , 36 , 49 , 59 , 66 ). Furthermore, adequate IgG levels during immunoglobulin replacement therapy and/or effective immunosuppressive therapies, including monoclonals, that target specific hyperactivated immune pathways dampening underlying inflammation before SARS-CoV-2 infection (i.e., tocilizumab, sirolimus, JAK inhibitors) have been associated with mild disease course ( 57 , 84 , 90 , 109 ). This evidence is not definitive given the paucity of data, and the clinical immunologist should be aware that guidelines for patients with rheumatological diseases treated with immunomodulatory medication recommend withholding the immunosuppression during symptomatic COVID-19 up to 2 wk after resolution of symptoms ( 111 ).…”