Tolerability of COVID-19 mRNA vaccines in patients with postural tachycardia syndrome

Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation.
There is increasing evidence that the etiology may be immune-mediated in a
subgroup of patients. Patients with POTS often experience an exacerbation
of their symptoms associated with infections and often fear the same
symptom aggravation after vaccination. With this data we conducted a study
to describe the tolerability of mRNA vaccines against COVID-19 and the
consequences of a COVID-19 infection on POTS symptoms in our cohort of
patients with neuropathic POTS.We conducted a standardized,
checklist-based interview with 23 patients and recorded the acute side
effects of mRNA vaccination, acute symptoms of COVID-19 infection as well
as the effects of vaccination and COVID-19 infection on POTS symptoms. The
following side effects were assessed in their presence (yes/no) and
duration (days): fever, shivering, fatigue, headache, joint pain, muscle
pain, nausea, emesis, diarrhea, and reaction at injection site (pain,
swelling and cutaneous reaction). For COVID-19 infection, the following
additional symptoms were queried: coughing, sore throat, rhinorrhea,
breathlessness, loss of taste, loss of smell and chest pain. For each
symptom, the presence (yes/no), severity (mild, moderate, severe) and
duration (in days) were evaluated. Furthermore, the duration of the
infection, need for hospitalization and incapacity for work were assessed.
To assess possible exacerbation of POTS symptoms, the presence (yes/no),
severity (mild, moderate, severe; for COVID-19 infection only) and
duration of symptom exacerbation (in days) for the following symptoms were
evaluated: dizziness, nausea, weakness, palpitations, lightheadedness,
tremulousness, blurred vision, concentration difficulties, memory
difficulties, orthostatic leg and/or arm pain, gastrointestinal symptoms,
sleep disturbances, restless legs syndrome and orthostatic headache. Our
observations suggest that mRNA vaccines are not associated with a higher
frequency of acute side effects in patients with POTS. Symptom
exacerbation as a consequence of mRNA vaccination seems to be less
frequent and of shorter duration compared to patients who suffered a
COVID-19 infection.   This study was carried out in accordance
with the recommendations of the local ethics committee (Kantonale
Ethikkommission Bern, Switzerland, project-ID: 2021-02115; 02.11.2021).