key: cord-0940631-mnfz0nha
authors: Maronese, Carlo Alberto; Di Zenzo, Giovanni; Genovese, Giovanni; Barei, Francesca; Monestier, Alice; Pira, Anna; Moltrasio, Chiara; Marzano, Angelo Valerio
title: Reply to “New‐onset bullous pemphigoid after inactivated Covid‐19 vaccine: Synergistic effect of the Covid‐19 vaccine and vildagliptin”
date: 2022-04-10
journal: Dermatol Ther
DOI: 10.1111/dth.15496
sha: ca1bc3e1837fb28c7e141dafb17812df6b54e49e
doc_id: 940631
cord_uid: mnfz0nha

nan

Recently, we came across three similar patients on dipeptidyl peptidase 4 inhibitors (DPP4-i) presenting with mild-to-moderate BP after vaccination with mRNA COVID-19 vaccines ( Table 1) Several cases of anti-SARS-CoV-2-vaccine-associated BP have been observed. 6 Clinically, two of our patients recalled the noninflammatory phenotype of gliptin-associated BP originally described by Japanese authors. Indeed, a latency of 1 year since culprit drug initiation would still fall in the range of DPP4-i-associated BP. 7 However, the timing suggests at least a contributing, synergistic role of the vaccine. A dysregulated immune response following anti-SARS-CoV-2 vaccination may target hemidesmosomal components more easily on a DPP4-inhibited background. In addition, DPP-4 is a cell-surface plasminogen receptor capable of converting plasminogen into plasmin, a serine protease that is in turn capable of cleaving BP180 ectodomain. 5 Inhibition of plasmin could provoke an altered processing of BP180 with a possible breakdown in immune tolerance of the antigen. Also, the additive role of mechanical injury secondary to intramuscular inoculation of the vaccine cannot be disregarded. 8, 9 Finally, it should be noted that the incidence of DPP4-i/vaccine-associated BP cases is very low when compared with the proportion of vaccinated elderly diabetic individuals on DPP4-i. Thus, an underlying individual predisposition unmasked by coincidental vaccination cannot be ruled out.

The authors declare no conflict of interest. 

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