Delayed systemic urticarial reactions following mRNA COVID-19 vaccination

Abstract

Background: As the vaccination campaign in response to the coronavirus disease 2019 (COVID-19) pandemic continues, concerns with regard to adverse reactions to the vaccine remain. Although immediate hypersensitivity reactions have received much attention, delayed systemic urticarial reactions after vaccination can occur. Objective: To describe the clinical presentation, vaccine excipient skin testing results, and outcomes of subsequent COVID-19 vaccination in patients who experienced delayed systemic urticarial reactions after messenger RNA (mRNA) COVID-19 vaccination. Methods: This was a retrospective case series of 12 patients referred to the Mayo Clinics in Rochester, Minnesota, and Jacksonville, Florida, between January 19, 2021, and April 30, 2021, for evaluation of delayed systemic urticarial reactions after mRNA COVID-19 vaccination. Demographics, medical and allergic history, reaction details, vaccine excipient skin testing results (when performed), and the outcome after subsequent vaccination were collected for each patient. Results: The mean age of the patients was 52 years, all were white, and 9 (75%) were women. Half of the patients had a history of drug allergy, and one had a history of chronic spontaneous urticaria. Seven patients reacted to the Pfizer-BioNTech vaccine and five reacted to the Moderna vaccine. Seven patients developed symptoms between 8 and 24 hours after vaccination. Nine patients required antihistamines for treatment. The median time to symptom resolution was 4 days. Nine patients underwent allergist-directed COVID-19 vaccine excipient skin testing, all of which were negative. Ten patients chose to receive their next mRNA COVID-19 vaccine dose, and four patients experienced recurrent delayed urticaria. Conclusion: Delayed systemic urticarial reactions after mRNA COVID-19 vaccination were not life-threatening, could be treated with antihistamines, and were not predicted with vaccine excipient skin testing. They were not a contraindication to subsequent vaccination, although patients should be counseled with regard to the possibility of recurrence.

Delayed urticaria after the third dose of mRNA COVID19 vaccine: A case series

“…In literature, more than 70% of cases of delayed urticaria to COVID19 vaccines were reported after the first vaccine dose, the remaining after the second one. 3 , 4 , 5 , 6 , 7 Accordingly to literature data, females resulted more frequently involved, 3 , 4 , 5 , 6 while our patients were younger than those reported in literature (fourth decade, mean age: 41.9 years). 3 , 4 , 6 , 7 …”

“… 3 , 4 , 5 , 6 , 7 Accordingly to literature data, females resulted more frequently involved, 3 , 4 , 5 , 6 while our patients were younger than those reported in literature (fourth decade, mean age: 41.9 years). 3 , 4 , 6 , 7 …”

“… 2 The implementation of massive vaccination campaigns to COVID19 infection has increased the attention to COVID19 vaccine hypersensitivity reactions, especially for immediate ones and rarely for delayed ones. Recently, some cases of delayed urticaria were reported after both the first and second COVID19 vaccine doses, 3 , 4 , 5 , 6 , 7 mostly after Pfizer‐BioNTech BNT162b2 and Moderna mRNA‐1273.…”

Chronic spontaneous urticaria after COVID-19 primary vaccine series and boosters

“…3,4 In the few reported cases, common demographic variables include female sex, middle age, and Caucasian race. 3,4,10 It is worth noting that these findings may be skewed toward those with access to vaccination.…”

Adverse Reactions to Anti-Infective Vaccines: an Emerging Problem in the COVID-19 Era

“…Urticaria/angioedema appearing hours or days after administration of a vaccine is unlikely allergy related [ 97 ]. If necessary, a new dose can be recommended following the usual procedure, with a 30-min observation period.…”