COVID-19 infection is associated with an elevated risk for autoimmune blistering diseases while COVID-19 vaccination decreases the risk: A large-scale population-based cohort study of 112 million individuals

• Published in: Journal of the American Academy of Dermatology 2024-11
• Main Authors: Curman, Philip, Kridin, Khalaf, Zirpel, Henner, Hernandez, Gema, Akyuz, Mehmet, Thaci, Diamant, Schmidt, Enno, Ludwig, Ralf J.
• Format: Article
• Language: English
• Subjects: autoimmune blistering diseases; Autoimmune disease; autoimmunity; COVID-19 infection; COVID-19 vaccination; pemphigoid; pemphigus; population-based cohort study
• ISSN: 0190-9622; 1097-6787; 1097-6787
• DOI: 10.1016/j.jaad.2024.10.063

Numerous diseases associated with COVID-19 infection and vaccination have been reported, including conditions such as the autoimmune blistering diseases (AIBD) pemphigus and pemphigoid. However, robust evidence supporting these associations is lacking. To investigate the risk of developing AIBD following COVID-19 infection and vaccination. Population-based retrospective cohort study utilizing data from over 112 million patients. The risk of AIBD within three months was compared among three cohorts: COVID-19 infection, COVID-19 vaccination, and controls, along with seven sensitivity analyses. COVID-19 infection was associated with an increased risk of AIBD (HR 1.508, 95% CI 1.260-1.805), with the risk being more pronounced for pemphigus (HR 2.432, 1.618-3.657) compared to bullous pemphigoid (HR 1.376, 1.019-1.857). Conversely, COVID-19 vaccination was associated with an almost halved risk of AIBD (HR 0.514, 0.394-0.672), with the risk reduction most significant for pemphigus (HR 0.477, 0.241-0.946). Comparisons between COVID-19 infection and vaccination revealed a more than threefold increased risk of AIBD in the infection cohort (HR 3.130, 2.411-4.063), particularly for pemphigus (HR 5.508, 2.973-10.205). Retrospective design and potential underreporting of COVID-19 cases and vaccinations. COVID-19 infection significantly increases the risk of AIBD while vaccination appears to reduce this risk.