Post COVID-19 Rise in Postural Orthostatic Tachycardia Syndrome and Antibody Deficiency: Exploring Immunoglobulin Therapy for Symptom Management 2309853

Abstract Introduction Since 2020, we’ve observed an increase in PI patients presenting with antibody deficiencies, despite previously reporting minimal illness or clinical stability before COVID. Concurrently, we’ve documented a rapid rise in Postural Orthostatic Tachycardia Syndrome (POTS). While a handful of POTS patients were seen before 2020, current clinic population is over 40, with an estimated 80% also demonstrating antibody deficiency, most commonly SAD. Methods We performed a retrospective review of patients, as part of an internal process improvement program, with SAD, POTS, and prior COVID infection who received IVIg either at home or our clinic. Results Cohort was female and a median age of 25 and dosing of 0.62g/kg/Q4 weeks/10months. ADRs were mainly headaches and fatigue, with 1 discontinuation due to an ADR. Functional impact included missed school/work and reliance on online education. IgG levels improved in most patients. Outcomes varied, with 2 reported improvements in syncope, dizziness, and activity tolerance, 1 noted improved energy without change in core POTS symptoms; 1 reported diminishing benefit; and 1 discontinued due to severe ADRs. Compared with other POTS treatments, IVIg was rated superior by 2 patients, neutral by 2, and intolerable by 1. Conclusion This review highlights a post COVID increase in patients presenting with both PI and POTS, with an overlap of SAD. IVIg was associated with improved IgG levels and in some, reduced syncope and fatigue, though responses were heterogeneous. The findings suggest possible immunologic contribution to POTS in the context of SAD, but the small sample size limits definitive conclusions. Future research should investigate links between new onset PI/SAD and POTS, the role of COVID in triggering dysautonomia, and whether IVIg can be systematically evaluated as a therapeutic option. Larger, studies are needed to determine whether recurrent infections and immune dysfunction worsen POTS symptoms and whether IVIg can meaningfully improve quality of life. Funding Source NA Topic Categories Translational and Interventional Immunology (TI)