Addendum October 9, 2021: Since I shared this article on social media, a friend of mine reported that after he got a second COVID-19 shot, he experienced allergic reactions controlled by anti-allergy medicines. However, the rash will return when he stops the antihistamine.
The infection enhancement by the COVID-19 vaccine by histamine release can also happen in adults. Another addendum was added at the bottom of the page.
ORIGINAL ARTICLE FOLLOWS
Synopsis
Infants can get anti-SARS-CoV-2 antibodies from their mother’s breastmilk. Mom’s antibodies can be from a previous coronavirus infection or COVID-19 vaccination.
When an infant gets sick with COVID-19, the symptoms are mostly mild and asymptomatic. If they have the anti-SARS-CoV-2 antibodies, it may neutralize the virus or cause histamine secretion from mast cells.
Histamine can cause rashes, diarrhea, runny nose, and shortness of breath. But at high levels, it can lead to shock and death.
Antibody-dependent enhancement (ADE) is the condition where the antibodies enhance disease rather than prevent infection. Diagnosis and treatment of ADE in infants and children are essential because there is treatment.
Why this article?
Currently, there is not much information about antibody-dependent enhancement in infants. This article is to raise awareness about it.
There is a lot of information here. The article is broken into sections and will be put together in the end. Numbers in brackets [number] are references.
There are reports from the Vaccine Adverse Event Reporting System (VAERS) about babies who had side effects after their mothers had their COVID-19 vaccine. Those reports will put bring the science discussed in this article to reality.
The end is a brief comparison of the multisystem inflammatory condition for children (MIS-C), Kawasaki Disease, and ADE and their treatment.
COVID-19 in Infants
From January to February 2020, the Chinese Center for Disease Control and Prevention reported a nationwide series of 2,135 pediatric patients with COVID-19. They found that for the less than 1-year-old, 7% were asymptomatic, 54.2% had mild symptoms, 33.2 with moderate, 8.8% has severeBreastmilk with a critical illness. Among the 2,135 patients, only one 14-year old died. [3]
How dangerous is COVID-19 in infants? A study of 45 countries showed that the estimated infection fatality rate for the 0-4 age group is 0.003.
The chance of an infant dying from COVID-19 is 1 in 300. [12], [15]
Anti-SARS-CoV-2 antibodies from Breastmilk
A study published in the Journal of the American Medical Association showed that mothers vaccinated with the Pfizer Biontech vaccine secrete anti-spike SARS-CoV-2 IgA and IgG antibodies in breast milk for six weeks after vaccination.[1]
IgA secretion was evident as early as two weeks after vaccination, followed by a spike in IgG after four weeks (a week after the second vaccine). IGA and IgG are explained below.
Breastmilk of mothers who recovered from COVID-19 also showed antibodies against the SARS-CoV-2. Those antibodies were able to neutralize the COVID-19 virus in a laboratory test. Fortunately, there was no detectable evidence of the SARS-CoV-2 virus by PCR swab test from the breast milk. In [2]
Classes of Antibodies
There are different classes of antibodies or immunoglobulins (Ig). The IgG, IgA, IgM, IgD and IgE. The IgGs are involved in viral and bacterial infections and are in the bloodstream.
The IgEs play a significant role in allergic reactions. IgAs are mainly in the respiratory and gastrointestinal tract linings and serve as a front-line defense against germs. They do so by binding with mast cells leading to their activation.
Some mast cells can have a receptor called (Fc gamma Receptor I) that increases their affinity to IgG. Any mast cell with a FcγRI can have an IgG readily attach to it.[6]
Parts of an antibody or immunoglobulin
An antibody is shaped like the letter Y. There is the Fab and the Fc. Fab is the antibody-binding fragment. The Fc is the crystalizable fragment. It is the trunk of the Y. (See image below)
The Fab sticks to a foreign particle or antigens like a bacteria or virus. After forming an antibody-antigen complex, the other cells or molecules of the immune system will attach to the Fc and destroy the whole complex. That is how the body gets rid of a foreign body.
Below is an example of the antibody attaching to a target cell, and then a Natural Killer cell comes by and kills the target cell.
Mast Cells
Mast cells are located in the skin and lining of the gut, respiratory tract, connective tissue, and blood vessels, and they are part of the immune system. Connective tissues connect one part of the body to another. They are the ligaments, cartilages, fat cartilage, joints, and bones. You can see a mast cell in any part of the body where a microbe can enter.
Inside the mast cells are granules containing different molecules like histamine and cell signaling molecules called cytokines. Cytokines participate in inflammation and allergy. When mast cells are activated, histamine and others are released by degranulation. Histamine presents differently depending on where they are.
Histamine release at the gastrointestinal tract causes diarrhea and abdominal pain. At the respiratory tract – runny nose, shortness of breath, cough, and wheezing. In the skin, itchiness, and hives. The eyes can get red and feel itchy. [5]
In antibody-dependent enhancement, there is a more tremendous amount of histamine released. This causes the smallest blood vessels, the capillaries, to constrict. This can lead to a cardiovascular collapse, decreased blood supply all over the body, causing multisystem organ failure. [5], [6]
Antibody-Dependent Enhancement
One mechanism of ADE is when the antibody allows the virus to enter the body’s white blood cells instead of preventing them. Once inside human cells, the virus replicates in the trillions, and severe infection follows.
ADE has been described before in children to make a vaccine for the Respiratory Syncytial Virus. A common cause of upper respiratory infection. [14]
ADE in Breastfed Infants
When the mother’s milk containing anti-SARS-CoV-2 antibodies, whether from a previous COVID-19 illness or vaccination, is fed to the infant, those antibodies circulate in the infant, and some, if not all, may have their Fc part attach to the mast cells.
If the baby gets exposed to someone with COVID-19, and they get the viruses, the majority of them will be asymptomatic and have mild symptoms. However, the virus will attract the anti-SARS-CoV-2 antibody bound to the mast cell and cause it to degranulate and release histamine.
The symptoms of histamine release were mentioned above, but the most common are hives, abdominal pain, diarrhea, increased mucus secretion, rapid breathing. How bad can the symptoms get? It can range from mild to deadly.
VAERS Reports About COVID-19 Vaccinated Mothers and their Breastfed Babies
Babies cannot verbalize their complaints. They can only cry and be fussy, and they are challenging to diagnose. Below are reports from the Vaccine Adverse Event Reporting System or VAERS about breastfed babies who had adverse reactions after their mothers had the COVID-19 injections.
Highlights are added. I did minor editing on spelling and punctuation. Click on the VAERS ID in red to see the full report.
Consider that according to the Lazarus report from the Harvard Pilgrim Health Center, less than 0.3% of all adverse drug events and only 1-13% of serious events, including deaths, are reported to the Food and Drug Administration (FDA). [11]
| VAERS ID: | 1025302 |
Write-up: Child got ill after breastfeeding post mother recovering Covid vaccine last week
| VAERS ID: | 978085 |
Write-up: Within 1-2hrs after the vaccine, the patient began repeatedly sneezing for the remainder of the day. Sore arm, chills, body aches, HA. The patient is breastfeeding. 24hr later, the infant began rubbing bilateral eyes and had redness on the skin bilaterally. No conjunctivitis. Eating w/o difficulty and otherwise acting fine. Did sleep longer than usual.
| VAERS ID: | 999040 |
Write-up: Breastfed, the son, has severe hives x 5 days
| VAERS ID: | 1025302 |
Write-up: Child got ill after breastfeeding post mother recovering Covid vaccine last week
| VAERS ID: | 1070803 |
Write-up: I was exclusively breastfeeding at the time of receiving both doses. My 4-month-old son developed diarrhea on February 1st, and it lasted 2 weeks. Lab work/stool studies were negative for any bacterial or viral infections.
| VAERS ID: | 1111787 |
Write-up: I am breastfeeding my daughter exclusively. She was born on December 9, 2020. She is roughly 3 months old. She had an all-body rash
| VAERS ID: | 970309 |
Write-up: The patient is breastfeeding her 5-month-old son. Two nights after her 1st Moderna dose, he had violent vomiting, diarrhea, body rash, and hematuria (bloody urine).
Those are the mild to moderate reactions. There are also severe reactions that lead to deaths.
| VAERS ID: | 1119088 |
Write-up: The patient received the first in the series covid vaccine at approximately 915… she breastfed her 12 month-old infants shortly thereafter without a problem. Around 1215 baby was getting fussy and breastfed for about 5 minutes before the baby broke out in hives.
EMS was called, and they administered epinephrine and diphenhydramine for course cough/wheezing, presumably anaphylaxis. Other foods consumed by the baby on the same day included a banana, a fig newton bar, dried apples, meat from the frozen meal, and a two-piece of cereal (new to baby).
ER course required 4 hours of monitoring but no other medical interventions.
| VAERS ID: | 1166062 |
Write-up: The patient received a second dose of Pfizer vaccine on March 17, 2020, while at work. March 18, 2020, her 5-month-old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever.
The patient brought the baby to the local ER, where assessments were performed; blood analysis revealed elevated liver enzymes. The infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother’s vaccination the previous day.
Note: TTP is thrombotic cytopenic purpura. TTP is a condition where blood clots form all over the body.
| VAERS ID: | 1532154 |
Write-up: On July 17, my baby passed away. I had been breastfeeding my 6-week old baby at the time that I received the first Pfizer vaccine on June 4, 2021. He became very sick with a high fever about 2 weeks after I got the first Pfizer vaccine on June 21. He was treated for 2 weeks with IV antibiotics for a supposed bacterial infection. However, they never found any specific bacteria and called his diagnosis culture-negative sepsis.
At the end of his hospital stay, he tested positive for rhinovirus. After the 14 day course of antibiotics, he was home for one week but exhibited strange symptoms (e.g., swollen eyelid, strange rashes, vomiting). I took him back to the hospital on July 15, where he presented with what they called an atypical Kawasaki disease. He passed away shortly thereafter from clots in his severely inflamed BreastmilkI am curious if the spike protein could have gone through the breast milk Breastmilk an inflammatory response in my child. They say Kawasaki disease presents very similarly to the Multi-System Inflammatory Syndrome in children that they see in post-Covid infections. (My baby also had unusual birth circumstances, as he was born at 37 weeks, triggered by maternal appendicitis.) However, if they know that antibodies go through the breastmilk as a good thing, then why wouldn’t the spike protein also go through the breastmilk and potentially cause problems.
Multisystem Inflammatory Syndrome, Kawasaki Disease and ADE
Multisystem Inflammatory Syndrome in Children (MIS-C) has been diagnosed in infants, children, and young adults associated with severe COVID-19. According to the Mayo Clinic,
Most children who become infected with the COVID-19 virus have only a mild illness. But in children who go on to develop MIS-C, some organs and tissues — such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin or eyes — become severely inflamed. Signs and symptoms depend on which areas of the body are affected.
A group of specialists wrote a letter to the Journal of Pediatrics and Pediatric Medicine, stating a significant overlap between MIS-C, Kawasaki disease, and ADE in children.[6]
Kawasaki Disease (KD) presents with similar symptoms to MIS-C, especially in severe forms such as Kawasaki Disease Shock Syndrome (KDSS) [6]
The similarities are in the table below from Kawasaki Disease, Disease, Multisystem Inflammatory Syndrome in Children: Antibody-Induced Mast Cell Activation Hypothesis.
The importance of the comparison is that the treatment are similar: intravenous gamma-globulin (IVIG), corticosteroids, and high-dose aspirin.
Besides IVIG, famotidine, famotidine+cetirizine, and montelukast, among others, are added for antibody-dependent enhancement. [10]
Addendum: October 9, 2021
Multi-System Inflammatory Syndrome in Adults – MIS after Vaccination-V
Multisystem inflammatory disease can happen in adults, after COVID-19 and its vaccination.
A 44-year old woman initially developed progressive fever, diarrhea, and abdominal pain. She had edema and swelling of her skin. Her course was complicated by blood clots in the lung, (pulmonary embolism) and acute kidney injury.
Take Away Message
Many people get vaccinated to enhance their immune systems and protect their loved ones. It is essential to know that vaccination has the potential to make things better or worse. Knowing the risk and benefits is critical. She was treated with intravenous antibiotics without success. However, when an intravenous steroid (methylprednisolone) was given, she has rapid improvement of her condition. [16]
Seek medical help if your baby has any reactions. In adults, watch out for persistent rash that is relieved by anti-allergy medicines like antihistamines.
Knowledge about Covid-19 is rapidly evolving. Information may update as new studies are made. Stay current by subscribing. Feel free to share and like.
Don’t Get Sick!
Related:
- The Updated List of COVID-19 Articles
- Antibodies to the Flu and COVID-19 Cross-React
- Antibody-dependent enhancement can happen to Delta Variant COVID-19
- What is Antibody-Dependent Enhancement, and why should you care.
- Who among the Vaccinated are At Risk of Dying if they get COVID-19?
- Highest Viral Loads among Delta Variant compared to other Variants: French Study
References:
- Perl SH, Uzan-Yulzari A, Klainer H, et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. 2021;325(19):2013–2014. doi:10.1001/jama.2021.5782
- Pace RM, Williams JE, Järvinen KM, et al. COVID-19 and human milk: SARS-CoV-2, antibodies, and neutralizing capacity. Preprint. medRxiv. 2020;2020.09.16.20196071. Published 2020 Sep 18. doi:10.1101/2020.09.16.20196071
- O’Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, Fontanet A, Cauchemez S, Salje H. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2021 Feb;590(7844):140-145. doi: 10.1038/s41586-020-2918-0. Epub 2020 Nov 2. PMID: 33137809.
- What is Antibody-Dependent Enhancement, and why should you care.
- Krystel-Whittemore M, Dileepan KN, Wood JG. Mast Cell: A Multi-Functional Master Cell. Front Immunol. 2016;6:620. Published 2016 Jan 6. doi:10.3389/fimmu.2015.00620
- Ricke DO, Gherlone N, Fremont-Smith P, Tisdall P, Fremont-Smith M. Kawasaki
Disease, Multisystem Inflammatory Syndrome in Children: Antibody-Induced Mast
Cell Activation Hypothesis. J Pediatrics & Pediatr Med. 2020; 4(2): 1-7 - Tkaczyk C, Okayama Y, Woolhiser MR, Hagaman DD, Gilfillan AM, Metcalfe DD. Activation of human mast cells through the high-affinity IgG receptor. Mol Immunol. 2002 Sep;38(16-18):1289-93. doi: 10.1016/s0161-5890(02)00077-9. PMID: 12217397.
- Yuanyuan Dong, Xi Mo, Yabin Hu, Xin Qi, Fan Jiang, Zhongyi Jiang, Shilu Tong. Epidemiology of COVID-19 Among Children in China
- Ricke DO. Two Different Antibody-Dependent Enhancement (ADE) Risks for SARS-CoV-2 Antibodies. Front Immunol. 2021;12:640093. Published 2021 Feb 24. doi:10.3389/fimmu.2021.640093
- Malone RW, Tisdall P, Fremont-Smith P, Liu Y, Huang XP, White KM, Miorin L, Moreno E, Alon A, Delaforge E, Hennecker CD, Wang G, Pottel J, Blair RV, Roy CJ, Smith N, Hall JM, Tomera KM, Shapiro G, Mittermaier A, Kruse AC, García-Sastre A, Roth BL, Glasspool-Malone J, Ricke DO. COVID-19: Famotidine, Histamine, Mast Cells, and Mechanisms. Front Pharmacol. 2021 Mar 23;12:633680. doi: 10.3389/fphar.2021.633680. PMID: 33833683; PMCID: PMC8021898.
- The Lazarus Report: Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP: VAERS)
- O’Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, Fontanet A, Cauchemez S, Salje H. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2021 Feb;590(7844):140-145. doi: 10.1038/s41586-020-2918-0. Epub 2020 Nov 2. PMID: 33137809.
- Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020 Jun;145(6):e20200702. doi: 10.1542/peds.2020-0702. Epub 2020 Mar 16. PMID: 32179660.
- Acosta PL, Caballero MT, Polack FP (December 16, 2015). “Brief History and Characterization of Enhanced Respiratory Syncytial Virus Disease.” Clin Vaccine Immunol. 23 (3): 189–95. doi:10.1128/CVI.00609-15. PMC 4783420. PMID 26677198.
- Number Converter and Risk Charts
- Nune A, Iyengar KP, Goddard C, Ahmed AE. Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V). BMJ Case Rep. 2021;14(7):e243888. Published 2021 Jul 29. doi:10.1136/bcr-2021-243888
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