From Immunization to Autoimmunity: A Deep Dive Into Post‐COVID‐19 Vaccine Reactions—A Narrative Review

Background and Aims: Coronavirus disease-2019 (COVID-19) emerged in 2019 from Wuhan, China, leading to the accelerated development of vaccines, which have proven instrumental in controlling the spread of the virus. While vaccination ceased the increasing trend of the viral infection, rare adverse autoimmune events emerged as important considerations. The present review captures the current evidence on reported cases of post-COVID-19 vaccination autoimmune and clinical presentations and their potential immunological mechanisms. We aim to inform healthcare providers about the spectrum of potential vaccine-related autoimmune responses, support timely diagnosis, and suggest considerations for patient management. Methods: We comprehensively searched Google Scholar, Scopus, and PubMed to find relevant studies on autoimmune events after COVID-19 vaccination. We prioritized studies that help understand the mechanisms, manifestations, and clinical management of autoimmune events associated with COVID-19 vaccines. Since this is a narrative review, we synthesized findings qualitatively from diverse study types, such as case reports and cohort studies, with no formal reanalysis and pooling. Results: Although causality relationship needs more studies for clarification, we found an increasing trend of reporting COVID-19 vaccine-associated autoimmune events, such as vaccine-induced immune thrombotic thrombocytopenia (VITT), Guillain-Barré (GBS), Graves' disease (GD), and autoimmune hepatitis (AH). We reported clinical manifestations, risk factors for developing the disease, and the importance of proper management in each autoimmune disease. Finally, we guided future investigation to clarify the risk factors and mechanistic pathways linking COVID-19 vaccination to autoimmune responses to have safer vaccinations in the future. Conclusion: Autoimmune reactions to COVID-19 vaccination are rare but need consideration. We suggest that each of these events can be controlled through personalized risk assessment and management of the autoimmune events. This aim can be achieved by focusing on unique aspects of post-vaccine autoimmune events, using novel approaches, risk assessors, and predictor tools such as AI-based analysis of predictive biomarkers.