Case series of chronic spontaneous urticaria following COVID-19 vaccines: an unusual skin manifestation

Abstract

Background Urticaria following the COVID-19 vaccine was rarely reported and had a short self-limited resolution. However, there has been relatively little literature published on CSU induced by COVID-19 vaccines. Purpose We describe a case series of patients who experienced CSU after SARS-CoV-2 vaccination. Methods A retrospective case series of 10 patients referred to the Department of Clinical Pharmacology of the University of Monastir (January 2021–January 2022) and included for evaluation of urticaria after COVID-19 vaccination. Results The median age was 31 years and patients were mostly female. Atopy was presented in 3 patients and urticaria was accompanied by angioedema in 6 patients. The median time interval between vaccination and the onset of urticaria was 28.5 h. The offended dose was the first one in 8 patients. The resolution of the eruption was observed at least 2 months later, despite the regular use of a full dose of antihistamine in nine patients. Polynuclear leucocytosis was identified in 5 patients. Anti-TPOAb was positive in one patient after receiving the BNT162b2 vaccine. Total serum IgE was elevated in 4 patients. Skin tests for the suspected vaccine as well as the vaccine excipient were negative. Conclusion We add to the medical literature ten new cases of chronic spontaneous urticarial reactions following COVID-19 vaccines uncontrolled with high-dose first-generation H1 antihistamines.

The effect of COVID-19 and COVID-19 vaccines on chronic spontaneous urticaria: single center experience

“…The improvement of the eruption was seen at least 2 months afterwards, despite the regular use of a high dose of first-generation H1 antihistamine in 9 cases. Among the included patients, 6 mRNA+2 inactive/ dead + 2 vector vaccines were received, and 9 patients presented with a new-onset skin reaction; nevertheless, it was a reactivation of preexisting urticaria in one of them [13]. Similar to the literature data, the mRNA vaccine was the most blamed COVID-19 vaccine, followed by the vector and inactivated vaccines [10][11][12][13].…”

“…Among the included patients, 6 mRNA+2 inactive/ dead + 2 vector vaccines were received, and 9 patients presented with a new-onset skin reaction; nevertheless, it was a reactivation of preexisting urticaria in one of them [13]. Similar to the literature data, the mRNA vaccine was the most blamed COVID-19 vaccine, followed by the vector and inactivated vaccines [10][11][12][13]. In a Turkish study, 181 (77 inactive, 104 mRNA) patients were vaccinated.…”

mRNA-LNP COVID-19 vaccine lipids induce low level complement activation and production of proinflammatory cytokines: Mechanisms, effects of complement inhibitors, and relevance to adverse reactions

“…anaphylatoxin/cytokine double hit) and start of symptoms can be reconciled. Examples for acute, subacute and chronic SAEs include the HSRs or anaphylaxis within minutes to hours [16][17][18][19] , heart inflammation [8][9][10][11][12][13][14][15] , coagulation disorders [21][22][23][24] , or skin diseases [25][26][27][28] can occur within days to months, and autoimmune phenomena 20 may arise without currently foreseeable time limit. A hypothesis that may explain these different latency periods postulates that the actions of effector immune cells, including the mast cells, basophil and neutrophil granulocytes, lymphocytes, macrophages and platelets, are discontinuous, graded in the sense that they manifest only after the activation state of their intracellular inflammatory signaling network reaches the reaction threshold.…”

“…Table 1 lists the vaccine's reported AEs categorized according to the affected organ systems. Of note, myocarditis/pericarditis [8][9][10][11][12][13][14][15] , HSRs/anaphylaxis [16][17][18][19] , autoimmune diseases 20 , thrombosis, thrombocytopenia and other coagulation disorders [21][22][23][24] skin [25][26][27][28] and ocular inflammations [29][30][31] , Guillain-Barre syndrome [32][33][34][35][36][37][38] and other neurologic problems 39,40 can all be linked to acute or subacute inflammatory processes that are also characteristic of SARS-CoV-2 infections.…”

SARS-CoV-2 vaccination complicated by small fiber neuropathy, mast cell activation syndrome, and pericarditis

“… 9 However, in a retrospective study of ten patients who received BPV, vaccination was complicated by spontaneous urticaria. 10 …”