Bullous Pemphigoid After COVID-19 Vaccination: Correspondence

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We would like to share ideas on the publication “Bullous Pemphigoid After Vaccination With the Inactivated Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine: Two Cases in China.”¹ Guo et al describe 2 verified cases of bullous pemphigoid (BP) in recipients of the inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination who have a history of cerebral infarction.¹ There were no anomalies in the baseline blood testing, according to Gou et al. The diagnosis of BP was supported by laboratory and histologic tests.¹ According to Guo et al, 2 patients in China who had the genetic background HLA-DQB1*0302 experienced BP following vaccination. However, there is insufficient data to suggest that genetic testing is necessary prior to receiving the inactivated SARS-CoV-2 vaccine.¹

We both agree that more inquiry is required to confirm the likelihood of the clinical link. It’s important to remember, though, that a layperson’s internet post does not always represent an accurate diagnosis. It is frequently still challenging to identify the precise clinical link because there is limited information available on the health and immunological status of vaccination recipients prior to injection. The patient’s comorbidities may be the cause of the problem and are open to misunderstanding.²

The vaccine recipient may have other co-occurring ailments in addition to their obvious clinical sickness. Before making any inferences about the existence of an adverse event connected to a vaccine, any further aggravating variables must be ruled out. Future research and careful planning are required. Additionally, research has shown that inherited genetic variation affects how vaccine recipients’ immune systems react. According to one study,³ which is not the same genetic variant as that stated in the current case report, inherited genetic variation affects how vaccine recipients’ immune systems respond. To rule out any further aggravating variables, such as co-morbidity or an underlying medical disease, a test must be conducted. For instance, dengue is a possible example from a prior paper.² It’s critical to assess the COVID-19 vaccine’s effectiveness in a group of individuals with a range of immunological and medical conditions.

1. Guo Z, Wang Y, Tang H, et al. Bullous pemphigoid after vaccination with the inactivated severe acute respiratory syndrome coronavirus 2 vaccine: two cases in China. Wound Manag Prev. 2022;68(11):22-25.
2. Kebayoon A, Wiwanitkit V. Dengue after COVID-19 vaccination: possible and might be missed. Clin Appl Thromb Hemost. 2021;27:10760296211047229. doi:10.1177/10760296211047229
3. Čiučiulkaitė I, Möhlendick B, Thümmler L, et al. GNB3 c.825c>T polymorphism influences T-cell but not antibody response following vaccination with the mRNA-1273 vaccine. Front Genet. 2022;13:932043. doi:10.3389/fgene.2022.932043