Covid vaccines could trigger idiopathic pulmonary fibrosis: the Rome Gemelli study
Covid vaccines could trigger an exacerbation in a minority of patients with idiopathic pulmonary fibrosis. This is what emerges from a study just published onAmerican Journal of Respiratory and Critical Care Medicine ‘ from Luca Richeldidirector of the Pneumology Unit of the Gemelli Irccs Polyclinic Foundation in Rome and former member of the Cts, the Scientific Technical Committee for the coronavirus emergency, together with Giacomo Sgalla.
What is Idiopathic Pulmonary Fibrosis (Ipf)
Idiopathic pulmonary fibrosis (IPF) is a rare disease with a poor prognosis, recalls a note from Gemini. It is estimated that they may be affected by this condition in Italy about 30-50,000 people. The disease progresses gradually with the development of respiratory insufficiency and its course can be characterized by moments of severe crises, called exacerbations (or exacerbations), which are burdened with a in-hospital mortality from 50 to 80%. “IPF is characterized by acute worsening of clinical conditions, which are in turn idiopathic – specifies Richeldi – In some cases they have been linked to an infectious cause or to a pulmonary thrombo-embolism. The true forms of acute exacerbation of the disease have a mortality. up to 80% and represent the main cause of death of these patients, which worsen rapidly over a few weeks. There is no specific therapy; high-dose corticosteroids are used, with quite poor results. catastrophic that should be intercepted promptly. All our 300 patients are alerted to the fact that a rapid worsening of symptoms requires an early warning to the attending physician or referral to the emergency room “.
Causes unknown, but 4 out of 10 patients had done so mRna vaccine
Just as the etiology of idiopathic pulmonary fibrosis is not known, therefore, the same is not known triggering causes of exacerbations, even if viral infections, exposure to environmental toxicants and dust are included among the risk factors. However, the Gemelli study adds important information: “Out of 10 patients hospitalized in 2021 for an episode of exacerbation in the context of idiopathic pulmonary fibrosis, at the Polyclinic which is one of the most important reference centers in Italy for this pathology, 4 presented a temporal relationship with the administration of a Covid mRna vaccine, occurred a few days before the episode.
In one patient the episode of exacerbation occurred after the first dose, in one after the second dose and in the remaining two after the dose booster“. Sgalla comments:” The temporal proximity between administration of the vaccine (carried out between 3 and 5 days before) and the onset of symptoms indicates the anti-Covid vaccine as the most likely trigger of acute exacerbation. “At the time of admission – report from Gemelli – these patients had high indexes of inflammation, and the CT scan was evident a widespread involvement of the pulmonary interstitium. All were subjected to treatment with high flow of oxygen and high doses of cortisone. Despite the timely therapy, two of these patients died during hospitalization.
“The study describes a rare event within a rare disease”
“In this study – explains Sgalla – we described a rare event that occurred in the context of a rare pathology; in our center we follow over 300 patients with IPF, who have all been subjected to anti-Covid vaccination. Only 4 of them were hospitalized for an exacerbation a few days after the anti-Covid vaccination. These post-vaccine flare-ups do not appear to have any particular characteristics. It is possible that in some of these patients the release of inflammatory cytokines, caused by vaccination, may have triggered this acute exacerbation. In the international guidelines on IPF to date, vaccinations are not listed among the risk factors for exacerbations. However, considering that similar cases, also very rare, have also been reported after H1N1 influenza vaccination, we suggest including antiviral vaccinations in the list of possible risk factors for Ipf exacerbations “.
“Last year – underlines Richeldi – we identified among the exacerbated patients admitted to our center a small number of cases, united by the fact that they have recently carried out the anti-Covid vaccination. It is certainly not a cause-effect demonstration – he specifies – but a temporal correlation that we wanted to point out for two reasons. The first is that i anti-Covid mRna vaccines they are new vaccines, which we suggest to include among the potential causes of an exacerbation. The other is to alert the doctors following these patients that there is a possibility, albeit a very remote one, that the vaccine could trigger an exacerbation. However, we reiterate the need for these patients to carry out anti-Covid vaccination as a matter of priority; because any interstitial pneumonia from Covid, on a patient who already has an interstitial pathology such as IPF, can have catastrophic effects “.
“The cost-benefit ratio remains in favor of the anti-Covid vaccine”
“So, in conclusion – assures Richeldi – the cost-benefit ratio remains largely in favor of anti-Covid vaccination and full cycle (3 full doses or 4 for those over 80). Knowing that there is a possibility of a flare-up is one more piece of information we have today. These patients must be closely monitored especially in the first 2 weeks after vaccination, even remotely, with a teleservice approach (tele-oximetry), to promptly highlight any desaturations of which the patient may not immediately perceive the extent, but which are important ” .
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