An infection with SARS-CoV-2 may not cause any adverse fetal outcomes in unvaccinated pregnant women with hereditary angioedema (HAE) if they are given prompt treatment, according to a recent article presenting 2 case reports published in The Journal of Allergy and Clinical Immunology: In Practice.

The first patient was a 20-year-old Hispanic female at 22 weeks gestation, with known HAE type 1. Her condition was successfully maintained on subcutaneous C1-INH at 60 IU/kg.

Prior to vaccine authorization and in the midst of the alpha variant peak, this patient tested positive for SARS-CoV-2 infection on a routine surveillance screening. She presented to the clinic with abdominal pain and extremity swelling and later reported sudden anosmia and ageusia.

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After receiving 2500 IU of intravenous human C1-INH, the initial symptoms of swelling and abdominal pain were resolved. The study authors reported no antenatal effects on fetal well-being.

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The second patient was a 24-year-old Hispanic female, at 27 weeks gestation, obese (BMI=40), with a history of seizure disorder and HAE type 1. She was maintained on subcutaneous C1-INH at 60 IU/kg with good disease control.

This patient refused COVID-19 vaccination prior to being exposed to household contact with COVID-19. Her initial symptoms included headache, cough, congestion, and nausea with vomiting. Upon presentation to the emergency department, the patient was hypoxic and required supplemental oxygen.

A chest X-ray showed lung hypoinflation and multifocal basilar consolidative opacities. She was initially treated with ceftriaxone and azithromycin as well as with remdesivir, dexamethasone, and baricitinib due to her risk profile. No additional C1-INH was administered and the pregnancy progressed as expected.

“Despite multiple independent risk factors for poor outcomes, our patients fared well. This might be attributed to C1-INH therapy blunting the dysregulated inflammatory response associated with HAE and COVID-19,” Salih and colleagues noted.

HAE and COVID-19 share a common pathophysiological mechanism that may lead to an exaggerated inflammatory response, including the activation of complement and coagulation systems, as well as the production of proinflammatory cytokines.


Salih A, Chin A, Gandhi M, Shamshirsaz A, Lombaard H, Hajjar J. Hereditary angioedema and COVID-19 during pregnancy – two case reports. J Allergy Clin Immunol Pract. Published online on December 23, 2022. doi:10.1016/j.jaip.2022.11.045