Prevalence, Pathophysiology, and Treatment of Urticaria post-COVID-19 Vaccination: A Systematic Review
DOI:
https://doi.org/10.35898/ghmj-62960Keywords:
Urticaria, Post-COVID-19 vaccination, mRNA vaccines, Whole inactivated virus, Hypersensitivity reactionsAbstract
Background: Vaccination for COVID-19 has been intensively developed since the end of 2020. Its use must also obtain an Emergency Use Authorization (EUA) permit. Some of the vaccines have been used including Sinovac, Astra Zeneca, Moderna, Pfizer, Johnson & Johnson, and Sinopharm. In fact, there are many effects that have developed after the COVID-19 vaccination administration like local reactions, systemic reactions, and other reactions. In addition, one of them is urticaria. However, the existing literature has focused poorly on urticaria caused by COVID-19 vaccines.
Aims: This research explores the prevalence, pathophysiology, and treatment of urticaria post-COVID-19 vaccination.
Methods: This study conducted a systematic review based on the guideline which is Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched Scopus, ProQuest, Ebsco, and Google Scholar databases from 2020 until 2022 for identifying the data regarding urticaria post-COVID-19 vaccination. In a nutshell, 9 studies were included in the systematic review.
Results: Only 28% of urticarial rashes incident among all cutaneous adverse reactions after post-COVID-19, it was higher among females and people aged 45-49 years old, and people with allergy histories. The most frequent reaction is urticarial following the COVID-19 vaccine administration. This concerns hypersensitivity reaction related to Immunoglobulin E (IgE) mediated, Immunoglobulin G (IgG), and sensitizing excipients in COVID-19 vaccines.
Conclusion: This systematic review raises the concern of hypersensitivity reaction that related to IgE-mediated, IgG, and sensitizing excipients in COVID-19 vaccines. Urticaria is the most frequent reaction after the COVID-19 vaccine administration. Attention to medical history and immunology/allergy consultation might be advantageous to assess the risk of allergy and the guidance of the vaccine.
Received: 9 May 2023; Revised: 8 June 2023; Accepted: 18 July 2023
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Akdaş, E., í–ğüt, B., Erdem, í–., í–ztaş, M. O., & ć°lter, N. (2021). Cutaneous reactions following CoronaVac COVID-19 vaccination: a case series of six healthcare workers from a single centre. Journal of the European Academy of Dermatology and Venereology : JEADV, 35(12), e861–e864. https://doi.org/10.1111/jdv.17592
AlMuhizi, F., Ton-Leclerc, S., Fein, M., Tsoukas, C., Garvey, L.H., Lee, D.,et al. (2022). Successful Desensitization to mRNA COVID-19 Vaccine In A Case Series of Patients with A History of Anaphylaxis to the First Vaccine Dose. Front. Allergy, 02 February 2022. https://doi.org/10.3389/falgy.2022.825164
Bermingham, W.H., Ardern-Jones, M.R., Huissoon, A.P., Krishna, M.T. (2021). Forewarned is Forearmed: Chronic Spontaneous Urticaria as A Potential Risk to Effective SARS-CoV-2 Vaccine Uptake and Global Public Health. British Journal of Dermatology (2021)185, pp838–839. https://doi.org/10.1111/bjd.20495
Bernstein, J.A., Singh, U., Rao, M.B., Berendts, K., Zhang, X., Mutasim, D. (2020). Benralizumab for Chronic Spontaneous Urticaria. N Engl J Med 2020; 383:1389-1391. DOI: 10.1056/NEJMc2016395
Bianchi, L., Biondi, F., Hansel, K., Murgia, N., Tramontana, M., Stingeni, L. (2021). Skin tests in urticaria/angioedema and flushing to Pfizer"BioNTech SARS"CoV"2 vaccine: Limits of intradermal testing. Wiley - Allergy. 2021 Apr 22 : 10.1111/all.14839. doi: 10.1111/all.14839
Brooks, S.G., De Jong, A.M., Abbaslou, M., Sussman, G. (2022). Chronic Spontaneous Urticaria Triggered by the AstraZeneca/Oxford COVID-19 Vaccine With Achieved Remission: A Case Report. SAGE - Allergy & Rhinology Volume 13: 1–2. https://doi.org/10.1177/21526567211068458
Bruusgaard-Mouritsen, M., Jensen, B.M., Poulsen, L.K., Johansen, J.D., Garvey, L.H. (2022). Optimizing Investigation of Suspected Allergy to Polyethylene Glycols. Journal of Allergy and Clinical Immunology Volume 149, Issue 1, January 2022, Pages 168-175.e4. https://doi.org/10.1016/j.jaci.2021.05.020
Burlando, M., Herzum, A., Cozzani, E., Parodi, A. (2021). Acute urticarial rash after COVID-19 vaccination containing Polysorbate 80. Korean Vaccine Society - Clinical Experimental Vaccine Research 2021 Sep; 10(3): 298–300. https://doi.org/10.7774/cevr.2021.10.3.298
Burlando, M., Herzum, A., Micalizzi, C., Cozzani, E., Parodi, A. (2021). Cutaneous Reactions to COVID-19 Vaccine at the Dermatology Primary Care. Wiley- Immunity, Inflammation and DiseaseVolume 10, Issue 2 p. 265-271. https://doi.org/10.1002/iid3.568
Catalí A, Muñoz-Santos C, Galván-Casas CR, Riesco MR, Nebreda D, Solá-Truyols A, et al. (2022). Cutaneous Reactions After SARS-CoV-2 Vaccination: A Cross Sectional Spanish Nationwide Study of 405 Cases. Dermatologists British Journal of Dermatology (2022)186, pp142–152.. https://doi.org/10.1111/bjd.20639
Cugno, M., Consonni, D., Lombardi, A., Bono, P., Oggioni, M., Renteria, S.U., et al. (2021). Increased Risk of Urticaria/Angioedema after BNT162b2mRNA COVID-19 Vaccine in Health Care Workers Taking ACE Inhibitors. Vaccines 2021, 9(9), 1011; https://doi.org/10.3390/vaccines9091011
Durmaz, K., Aykut Temiz, S., Metin, Z., Dursun, R., & Abdelmaksoud, A. (2022). Allergic and cutaneous reactions following inactivated SARS-CoV-2 vaccine (CoronaVac®) in healthcare workers. Clinical and experimental dermatology, 47(1), 171–173. https://doi.org/10.1111/ced.14896
Farinazzo, E., Ponis, G., Zelin, E., Errichetti, E., Stinco, G., Pinzani, C., et al. (2021). Cutaneous adverse reactions after m-RNA COVID-19 vaccine: early reports from Northeast Italy. Journal of the European Academy of Dermatology and Venereology : JEADV, 35(9), e548–e551. https://doi.org/10.1111/jdv.17343
Grieco, T., Ambrosio, L., Trovato, F., Vitiello, M., Demofonte, I., Fanto, M., et al. (2022). Effects of Vaccination against COVID-19 in Chronic Spontaneous and Inducible Urticaria (CSU/CIU) Patients: A Monocentric Study. Journal of Clinical Medicine. 2022; 11(7):1822. https://doi.org/10.3390/jcm11071822
Gronbeck, C. and Grant-Kels, J. M. (2021). Attention All Anti-Vaccinators: The Cutaneous Adverse Events From The mRNA COVID-19 Vaccines Are Not An Excuse to Avoid Them. Clinics in Dermatology Volume 39, Issue 4, July–August 2021, Pages 674-687. https://doi.org/10.1016/j.clindermatol.2021.05.027
Kaya, L., and Kaya, Z. (2022). A Case Report Of A Nurse Who Received The COVID-19 Vaccine. International Journal of PharmATA 2022; 2(2): 9-14.
Macy, E., Pandya, S., Sheikh, J., Brunette, A., M.Shi, J., Chung, J.,et al. (2022). Population Based Incidence, Severity, and Risk Factors Associated with Treated Acute-Onset COVID-19 mRNA Vaccination-Associated Hypersensitivity Reactions. The Journal of Allergy and Clinical Immunology: In Practice Volume 10, Issue 3, March 2022, Pages 827-836. https://doi.org/10.1016/j.jaip.2021.12.021
Magro, C., Crowson, N., Franks, L., Schaffer, P.R., Whelan, P. Nuovo, G. (2021). The histologic and Moleculer Correlates of COVID-19 Vaccine-Induced In The Skin. Clinics in Dermatology Volume 39, Issue 6, November–December 2021, Pages 966-984. https://doi.org/10.1016/j.clindermatol.2021.07.011
Magro, C., Nuovo, G., Mulvey, J., Laurence, J., Harp, J., Crowson, A.N. (2021). The skin as a critical window in unveiling the pathophysiologic principles of COVID-19. Elsevier- Clinics in Dermatology Volume 39, Issue 6, November–December 2021, Pages 934-965. https://doi.org/10.1016/j.clindermatol.2021.07.001
Namazi, N., Diab, R., Mardani, G., Jamali, E., Kaddah, A. (2022). Figurate Purpuric Eruption Post-COVID-19 Vaccination. Dermatologic Therapy.2022;35:e15360. https://doi.org/10.1111/dth.15360
Pitlick, M.M., Joshi, A.Y., Gonzalez-Estrada, A., Chiarella, S.E. (2022). Delayed Systematic Urticarial Reactions Following mRNA COVID-19 Vaccination. Allergy and Asthma Proceedings, Volume 43, Number 1, 1 January 2022, pp. 40-43(4). https://doi.org/10.2500/aap.2022.43.210101
Pourani, MR, Shahidi Dadras, M, Salari, M, Diab, R, Namazi, N, Abdollahimajd, F. (2022). Cutaneous adverse events related to COVID-19 vaccines: A cross-sectional questionnaire-based study of 867 patients. Dermatologic Therapy. 2022; 35( 2):e15223. DOI:10.1111/dth.15223
Rerknimitr, P., Puaratanaarunkon, T., Wongtada, C., Wittayabusarakam, N., Krithin, S., Paitoonpong, L., et al. (2022), Cutaneous adverse reactions from 35,229 doses of Sinovac and AstraZeneca COVID-19 vaccination: a prospective cohort study in healthcare workers. J Eur Acad Dermatol Venereol, 36: e158-e161. https://doi.org/10.1111/jdv.17761
Smola, A., Samadzadeh, S., Müller, L., Adams, O., Homey, B., Albrecht, P.,et al. (2021). Omalizumab prevents anaphylactoid reactions to mRNA COVID-19 vaccine. Journal of the European Academy of Dermatology and Venereology : JEADV, 35(11), e743–e745. https://doi.org/10.1111/jdv.17549
Suan, D., and Lee, A.Y.S. (2022). Chronic spontaneous urticaria following ChAdOx1-SCOVID-19 vaccination. Springer - Allergo J Int. (2022). https://doi.org/10.1007/s40629-022-00204-x
Triwatcharikorn, J., Puaratana-arunkon, T., Punyaratabandhu, P., Mongkolpathumrat, P., Palapinyo, S., Buranapraditkul, S., et al. (2022), Acute urticaria alone after CoronaVac COVID-19 vaccination should not be a contraindication for revaccination. Clin Exp Dermatol, 47: 735-738. https://doi.org/10.1111/ced.14962
Worm, M., Bauer, A., Wedi, B., Treudler, R., Pfuetzner, W., Brockow, K., et al. (2021). Practical Recommendations For The Allergological Risk Assessment of The COVID-19 Vaccination - A Harmonized Statement of Allergy Centers in Germany. Allergologie select, 5, 72–76. https://doi.org/10.5414/ALX02225E
Zuberbier, T., Hamzah, A. L., Abuzakouk, M. Aquailina, S., Asero, R., et al. (2022). The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Wiley- Allergy 2022;77:734–766. https://doi.org/10.1111/all.15090
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