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Severe nonanaphylactic allergic reaction: case reportA 36-year-old woman developed severe nonanaphylactic allergic reaction following administration of tozinameran for COVID-19 immunisation.The woman received first dose of intramuscular ( in right deltoid) tozinameran [dosage not stated] [pfizer-BioNTech COVID-19 vaccine] injection and after 3 hours from receiving tozinameran, she developed a pruritic, painful rash on her face, arms, forearms, scalp and back. Her rash persisted and after 4 days her eyelids began to swell. It was reported that, she had no previous history of adverse reaction to vaccinations. She only reported, dermatologic history of brief episode of pityriasis rosea 4 years previously. Moreover, she did not had any history of dermal filler injections. Prick allergy testing for postnasal drip 20 years previously was negative. Thereafter, she received several doses of loratadine but did not observed remarkable improvement. After 8 days from vaccination, she presented to the hospital where clinical evaluation showed severe edematous eyelids nearly swollen shut and facial oedema. Additionally, there was marked erythema and superficial desquamation of the ears, face and neck with scattered morbilliform edematous pink papules on the upper portion of the back, chest and both arms. She did not had shortness of breath, cough, mucosal swelling, fever, dyspnea nor other systemic symptoms. Laboratory findings including comprehensive metabolic panel, complete blood count and C4 complement, were within the normal limits, including no peripheral eosinophilia or transaminitis. Therefore, she was considered to have severe nonanaphylactic allergic reaction.Thereafter, the woman received prednisone in tapering doses with loratadine being continued along with triamcinolone. It was reported that her edema responded immediately to a prednisone taper, continuing loratadine and triamcinolone. Subsequently, her rash resolved within 5 days. At the time of vaccination, she was 8 months postpartum and was breastfeeding multiple times daily. Afterwards, she was advised to avoid the second dose of the vaccine. It was reported that 6 months since presentation, she was well without other sequelae at the time of this manuscript writing. The development of severe nonanaphylactic allergic reaction was attributed to tozinameran.
Severe nonanaphylactic allergic reaction: case reportA 36-year-old woman developed severe nonanaphylactic allergic reaction following administration of tozinameran for COVID-19 immunisation.The woman received first dose of intramuscular ( in right deltoid) tozinameran [dosage not stated] [pfizer-BioNTech COVID-19 vaccine] injection and after 3 hours from receiving tozinameran, she developed a pruritic, painful rash on her face, arms, forearms, scalp and back. Her rash persisted and after 4 days her eyelids began to swell. It was reported that, she had no previous history of adverse reaction to vaccinations. She only reported, dermatologic history of brief episode of pityriasis rosea 4 years previously. Moreover, she did not had any history of dermal filler injections. Prick allergy testing for postnasal drip 20 years previously was negative. Thereafter, she received several doses of loratadine but did not observed remarkable improvement. After 8 days from vaccination, she presented to the hospital where clinical evaluation showed severe edematous eyelids nearly swollen shut and facial oedema. Additionally, there was marked erythema and superficial desquamation of the ears, face and neck with scattered morbilliform edematous pink papules on the upper portion of the back, chest and both arms. She did not had shortness of breath, cough, mucosal swelling, fever, dyspnea nor other systemic symptoms. Laboratory findings including comprehensive metabolic panel, complete blood count and C4 complement, were within the normal limits, including no peripheral eosinophilia or transaminitis. Therefore, she was considered to have severe nonanaphylactic allergic reaction.Thereafter, the woman received prednisone in tapering doses with loratadine being continued along with triamcinolone. It was reported that her edema responded immediately to a prednisone taper, continuing loratadine and triamcinolone. Subsequently, her rash resolved within 5 days. At the time of vaccination, she was 8 months postpartum and was breastfeeding multiple times daily. Afterwards, she was advised to avoid the second dose of the vaccine. It was reported that 6 months since presentation, she was well without other sequelae at the time of this manuscript writing. The development of severe nonanaphylactic allergic reaction was attributed to tozinameran.
Although vaccination is widely accepted as an effective method of preventing and controlling the COVID‐19 pandemic, many people are concerned about possible cutaneous side‐effects, which can delay or prevent them from being vaccinated. The objectives of this systematic review were to assess the global prevalence and clinical manifestations of cutaneous adverse reactions following COVID‐19 vaccination. PubMed and Scopus databases were searched for articles published from 1 January 2019 to 31 December 2021, and reference lists for each selected article were screened. Case reports, case series, observational studies and randomized controlled trials that provided information on cutaneous adverse reactions following COVID‐19 vaccines were included. A total of 300 studies were included in a systematic review of which 32 studies with 946 366 participants were included in the meta‐analysis. The pooled prevalence of cutaneous manifestations following COVID‐19 vaccination was 3.8% (95% CI, 2.7%–5.3%). COVID‐19 vaccines based on the mRNA platform had a higher prevalence than other platforms at 6.9% (95% CI, 3.8%–12.3%). Various cutaneous manifestations have been reported from injection site reactions, which were the most common (72.16%) to uncommon adverse reactions such as delayed inflammatory reactions to tissue filler (0.07%) and flares of pre‐existing dermatoses (0.07%). Severe cutaneous reactions such as anaphylaxis have also been reported, but in rare cases (0.05%). In conclusion, cutaneous adverse reactions are common, especially in those receiving mRNA vaccines. Most reactions are mild and are not contraindications to subsequent vaccination except for anaphylaxis, which rarely occurs. COVID‐19 vaccination may also be associated with flares of pre‐existing dermatoses and delayed inflammatory reactions to tissue filler. Patients with a history of allergies, pre‐existing skin conditions or scheduled for filler injections should receive additional precounselling and monitoring. A better understanding of potential side‐effects may strengthen public confidence in those wary of new vaccine technologies.
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