Exacerbation of Chronic Spontaneous Urticaria Symptoms in COVID-19 Patients, Case Report

Abstract

Chronic spontaneous urticaria (CSU) is characterized by wheals lasting more than 6 weeks and can be accompanied by angioedema. Treatment of the disease varies depending on the severity and includes first-line therapeutics such as non-sedative antihistamines. Second- and third-line treatments are used in severe and uncontrolled form of CSU. Environmental exposure and infections could trigger worsening symptoms. The goal of this study is to assess the effect of SARS-CoV-2 infection on CSU symptoms and the efficacy of the second- and third-line therapeutics for CSU management in COVID-19 patients. Our findings show that SARS-CoV-2 infection exacerbates CSU symptoms. Worsening of disease was indicated by decreased Urticaria Control Test (UCT) and increased Urticaria Activity Score (UAS). Treatment management was modified by switching to second- and third-line therapeutics; however, therapeutic control was achieved only in one patient. Our data demonstrates that SARS-CoV-2 infection contributes to the severity of CSU. Symptoms of CSU are more challenging to manage and require changes in treatment protocol, including second- and third-line therapeutics. We believe that severe inflammation triggered by SARS-CoV-2 infection contributes to the worsening of CSU symptoms.

New-onset chronic spontaneous urticaria post–COVID-19 vaccination—South African case series

“… 13 At the time of writing, there was no available literature describing new-onset CSU post–COVID-19 infection, only the exacerbation of symptoms in a fifth of known patients with CSU. 14 , 15 However, in the authors’ experience, new-onset CSU can occur post–COVID-19 infection. Various studies have described cutaneous reactions post–COVID-19 vaccination and, after local injection-site reactions, urticaria and angioedema are the most common cutaneous adverse events.…”

CRUSE®—An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria

“…It is characterised by itchy recurrent wheals and/or angioedema that recur for longer than 6 weeks 1,2 . The signs and symptoms of CSU develop spontaneously, although drugs, infection 3 and high stress levels 4 can exacerbate the disease activity 5 . Many patients experience a protracted disease course that can last several years 1,6 .…”