Are SARS‐CoV‐2 IgA antibodies in paediatric patients with chilblain‐like lesions indicative of COVID‐19 asymptomatic or paucisymptomatic infection?
A Diociaiuti, S Giancristoforo, S Terreri, M Corbeddu, C Concato, M Ciofi Degli Atti, G Zambruno, R Carsetti, M El Hachem
Journal of the European Academy of Dermatology and Venereology, doi:10.1111/jdv.16934
was positive in eight cases, borderline in two, and negative in three, including the COVID-19 patient. Overall, serology for S1-specific IgA and IgG in the 30 patients shows that 16 (53.3%) were positive for IgA, whereas IgG was detectable in five (16.6%; Fig. 1f ). We have recently reported that high levels of IgG and IgA can be detected in adult patients with severe COVID-19, while IgA, and to a lower extent IgG, is increased in asymptomatic individuals. 6 As IgA is the most abundant antibody at mucosal sites, a strong local protection may prevent viral spread and damage to the respiratory tract, explaining the lack of symptoms. The ELISA used for the detection of anti-S1 IgG and IgA has been demonstrated to be specific and sensitive. 7, 8 Of note, antibodies against S1 are often neutralizing 9 and may prevent severe disease and further immune responses. 6 Our findings indicate that, similar to asymptomatic adults, paediatric patients would respond to SARS-CoV-2 producing more IgA than IgG. On the other hand, a single patient had detectable IgG against SARS-CoV-2 nucleoprotein. Anti-nucleoprotein IgG is present in the great majority of hospitalized adult patients, but only in one-third of paucisymptomatic individuals, suggesting that disease severity influences the specificity of the antibodies produced. 10 In conclusion, the detection of S1-specific IgA in paediatric patients with chilblain-like lesions strongly points to a previous, mostly asymptomatic SARS-CoV-2 infection with inflammatory sequelae.
Conflicts of interest None to be reported for all authors. A. Diociaiuti, 1,*, † S. Giancristoforo, 1, † S. Terreri, 2 M. Corbeddu, 1 C. Concato, 3 M. Ciofi Degli Atti, 4 G. Zambruno, 5 R. Carsetti, 6, † M. El Hachem 1, †
Conflicts of interest None declared.
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