Effect of SARS-CoV-2 BNT162b2 mRNA vaccine on thyroid autoimmunity: A twelve-month follow-up study.

Objectives: Graves' disease (GD) has been highlighted as a possible adverse effect of the respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine. However, it is unknown if the SARS-CoV-2 vaccine disrupts thyroid autoimmunity. We aimed to present long-term follow-up of thyroid autoimmunity after the SARS-CoV-2 BNT162b2 mRNA vaccine. Methods: Serum samples collected from seventy Japanese healthcare workers at baseline, 32 weeks after the second dose (pre-third dose), and 4 weeks after the third dose of the vaccine were analyzed. The time courses of anti-SARS-CoV-2 spike immunoglobulin G (IgG) antibody, thyroid-stimulating hormone receptor antibody (TRAb), and thyroid function were evaluated. Anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) were additionally evaluated in thirty-three participants. Results: The median age was 50 (IQR, 38-54) years and 69% were female. The median anti-spike IgG antibody titer was 17627 (IQR, 10898-24175) U/mL 4 weeks after the third dose. The mean TRAb was significantly increased from 0.81 (SD, 0.05) IU/L at baseline to 0.97 (SD, 0.30) IU/L 4 weeks after the third dose without functional changes. An increase in TRAb was positively associated with female sex (ß = 0.32, P = 0.008) and low basal FT4 (ß = -0.29, P = 0.02) and FT3 (ß = -0.33, P = 0.004). TgAb was increased by the third dose. Increase in TgAb was associated with history of the thyroid diseases (ß = 0.55, P <0.001). Conclusions: SARS-CoV-2 BNT162b2 mRNA vaccine can disrupt thyroid autoimmunity. Clinicians should consider the possibility that the SARS-CoV-2 vaccine may disrupt thyroid autoimmunity.

[SEVERE INFANTILE ASTHMA TREATED WITH LONG-ACTING MUSCARINIC ANTAGONIST: A CASE SERIES].

BACKGROUND: Long-acting muscarinic antagonists (LAMA) are used for long-term treatment of bronchial asthma in adults. Its use in the management of pediatric bronchial asthma, however, is currently not approved in Japan. Nonetheless, there have been a few reports of its use in children, particularly in cases of severe bronchial asthma or those without atopic disease that are refractory to existing treatment protocols. We report the progress of LAMA in infantile asthma patients. CASES: Three out of four patients had LAMA introduced at 3 to 5 years of age after being diagnosed with asthma at 1 to 3 years old. Three patients had non-IgE-related asthma and an underlying disease, such as Apert and Noonan syndrome, while one patient had severe IgE-related asthma without a pre-existing disease. In all cases, conventional long-term medications such as medium to high-dose inhaled corticosteroids and long-acting beta-agonists, were given. However, severe bronchial asthma persisted, with some patients having uncontrolled secretions. Since uncontrolled severe-persistent bronchial asthma results in repeated hospitalization and intensive care unit admission, we introduced LAMA, specifically 2.5µg/day of tiotropium (Tio). After the introducing Tio, none of the patients had an acute exacerbation that required hospitalization and the frequency of wheezing was reduced. LAMA was administered for up to 19 months, with no adverse events. CONCLUSION: The results of this series suggest that LAMA is an effective and safe option for uncontrolled infantile asthma.

[FOOD-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS IMPROVED BY OMALIZUMAB PRESCRIBED FOR IDIOPATHIC CHRONIC URTICARIA].

A 13-year-old male patient suffered several episodes of anaphylaxis during exercise after consuming wheat. Provocation tests (consisting of exercise after wheat ingestion) were conducted twice at our hospital. Both tests were positive, resulting in a diagnosis of food-dependent exercise-induced anaphylaxis (FDEIA) due to wheat. The patient was instructed to avoid exercise after wheat ingestion. The patient had also been previously diagnosed with idiopathic chronic urticaria, which was treated with antihistamines and leukotriene receptor antagonists. Since the idiopathic chronic urticaria worsened despite the use of these medications, 300 mg per four weeks of omalizumab was initiated. The patient's symptoms improved, and a third provocation test came back negative. The patient was asymptomatic without exercise restriction when treated with omalizumab. Omalizumab is not typically prescribed for treating food allergies and EIA in Japan; however, there are some reports on their effectiveness in treating them, suggesting omalizumab may also be helpful in resolving FDEIA symptoms.