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Delayed urticaria instances attributed to COVID-19 vaccination

March 15, 2023

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Chu SR, et al. Summary 420. Offered at: AAAAI Annual Assembly; Feb. 24-27, 2023; San Antonio.

Chu reviews no related monetary disclosures.

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Key takeaways:

  • Six sufferers had pre-existing persistent spontaneous urticaria that acquired worse, and 14 developed novel delayed urticaria.
  • Signs developed between 8 hours and a pair of weeks after vaccination.

SAN ANTONIO — Twenty sufferers at College of Washington allergy clinics developed delayed urticaria attributable to COVID-19 vaccination, in response to knowledge offered on the American Academy of Allergy, Bronchial asthma & Immunology Annual Assembly.

“We checked out what forms of vaccinations individuals obtained, their therapies and responses, and the durations of their signs, amongst different issues,” Stacey R. Chu, MD, an internist with SSM Well being Saint Louis College Hospital, mentioned throughout her presentation.

Researchers attributed 20 instances of urticaria at College of Washington allergy clinics to COVID-19 vaccination. Picture: Adobe Inventory

The retrospective chart overview analyzed sufferers with urticaria who visited allergy clinics on the College of Washington between Dec. 14, 2020, and Dec. 14, 2021. The researchers decided 20 sufferers had urticaria attributed to COVID-19 vaccinations.

Six of those sufferers had pre-existing persistent spontaneous urticaria that acquired worse after vaccination. Additionally, 14 skilled novel improvement of delayed urticaria after vaccination.

These developments occurred between 8 hours and a pair of weeks after vaccination with the primary or second dose of the Pfizer or Moderna COVID-19 vaccines.

By vaccine and dose, three sufferers developed signs after the primary Moderna dose, 4 after the second Moderna dose, six after the primary Pfizer dose and 6 after the second Pfizer dose. One affected person obtained each the Moderna and Pfizer vaccine.

The clinics handled sufferers with H1-antihistamines, H2-antihistamines, leukotriene inhibitors, oral steroids, omalizumab (Xolair; Genentech, Novartis), cyclosporine and acupuncture.

“Within the Pfizer group, all sufferers had been managed with antihistamines and didn’t require separate remedy,” Chu mentioned. “However within the Moderna group, some sufferers did want omalizumab and cyclosporine to manage signs.”

Particularly, 33% of the sufferers who had obtained the Pfizer vaccine obtained steroids earlier than they had been evaluated by the allergy clinic. The sufferers who had obtained the Moderna vaccine didn’t obtain any steroids.

These outcomes point out why it is vital for major care suppliers to determine urticaria and refer sufferers to an allergist, the researchers mentioned. Additionally, the researchers mentioned that these variations between sufferers who did and didn’t obtain steroids increase questions in regards to the mechanism of delayed urticaria after COVID-19 vaccination.

“Sufferers total had enchancment inside a yr, typically inside 6 months, and a few sufferers had full decision,” Chu mentioned.

Some sufferers skilled enhancements inside 1 month. Nevertheless, 65% of sufferers skilled urticaria for greater than 6 weeks earlier than signs improved. Greater than half of those sufferers skilled enhancements inside 6 months, and a few had full decision.

Sufferers who didn’t expertise full decision required therapy, sometimes antihistamines alone, to keep up manageable ranges of signs.

The researchers don’t advocate that sufferers who develop urticaria or who expertise worse signs in pre-existing urticaria keep away from additional COVID-19 vaccinations.

All of the sufferers who had obtained the Pfizer vaccine continued to obtain further vaccination, however greater than half of the sufferers who had obtained the Moderna vaccine discontinued their vaccination program.

Specifically, the sufferers who didn’t obtain step-up remedy with omalizumab and cyclosporine all obtained further vaccination, whereas sufferers with extra extreme instances selected to keep away from subsequent vaccination.

These variations indicated that vaccine hesitancy is a barrier, the researchers mentioned, though a greater understanding of this situation and affected person schooling could alleviate these issues.

“We do have plans to dive in additional with a follow-up overview,” Chu mentioned.

The researchers mentioned they may analyze further knowledge they’ve gathered for the reason that first overview, on the lookout for developments whereas evaluating the overview teams. These additional analyses will incorporate affected person reported knowledge as nicely.

“We hope that with this bigger variety of sufferers, we can have extra info that can elucidate a few of these attention-grabbing findings from our first examine,” Chu mentioned.



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