Immunizing the Imperfect Immune System: COVID-19 Vaccination in Patients with Inborn Errors of Immunity

Document Type

Journal Article

Publication Date



Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology




COVID-19; Immunodeficiency; Inborn Errors of Immunity; SARS-CoV-2; vaccination


OBJECTIVE: To update clinicians on current evidence regarding the immunogenicity and safety of COVID-19 vaccines in patients with Inborn Errors of Immunity (IEI). DATA SOURCES: Peer reviewed, published studies in Pubmed, clinical trials listed on clinicaltrial.gov, and professional organization and governmental guidelines. STUDY SELECTIONS: Literature searches on Pubmed and clinicaltrials.gov were performed using a combination of the following keywords: Primary Immunodeficiency, COVID-19, SARS-CoV-2, vaccination RESULTS: Twenty-six studies met criteria and were included in this review. Overall, antibody responses to COVID-19 vaccination were seen in 72% of study subjects, with stronger responses observed following mRNA vaccination. Neutralizing antibodies were detected in IEI patients, though consistently at lower levels than healthy controls. Risk factors for poor antibody responses included diagnosis of common variable immunodeficiency (CVID), presence of autoimmune comorbidities, and use of rituximab. T cells responses were detectable in most patients with IEI, with poorer responses often seen in CVID patients. Safety of COVID-19 vaccines in patients with IEI were acceptable with high rates of reactogenicity but very few serious adverse events, including in patients with immune dysregulation. CONCLUSION: COVID-19 vaccines are safe in patients with IEI and appear to be immunogenic in most individuals, with stronger responses seen following mRNA vaccinations.