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).We conducted a standardized checklist-based interview. Data analysis was descriptive