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Alergologia Polska - Polish Journal of Allergology
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2/2024
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Opis przypadku

The effect of COVID-19 and COVID-19 vaccines on chronic spontaneous urticaria: single center experience

Öner Özdemir
1
,
Ümmügülsüm Dikici
1

  1. Department of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Sakarya University, Research and Training Hospital of Sakarya University, Sakarya, Türkiye
Alergologia Polska – Polish Journal of Allergology 2024; 11, 2: 180–183
Data publikacji online: 2024/04/03
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INTRODUCTION

Chronic spontaneous urticaria (CSU) is known by spontaneous urticarial lesions and/or angioedema resisting ≥ 6 weeks [1]. It is reported in the literature that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the body and can trigger urticaria and angioedema, and even might cause new-onset CSU [2]. Although coronavirus disease 2019 (COVID-19) vaccines do not generally affect patients with CSU, it has been observed that they occasionally exacerbate the disease [3, 4].

AIM

In this study, we investigated the effects of COVID-19 and COVID-19 vaccines on our CSU cases.

CASE REPORT

The files of 16 CSU cases of the Department of Pediatric Allergy and Immunology at a University Training and Research Hospital were retrospectively evaluated. (Non-interventional ethics committee approval number: E-71522473-050.01.04-259122-292.) Five of the cases were male and 11 were female. The mean age was 17.9 ±3.2 (min.–max.: 13–25) years. Of 16 cases, 9 cases (1 case – inactive Sinovac®, 8 cases – mRNA Pfizer- BioNTech®) were administered the vaccine.

14 out of 16 patients did not get SARS-CoV-2 infection (until 1 year after vaccination). Two people were infected and urticaria did not develop in one of them, but she was using omalizumab at the same time (Table 1). In the other patient, urticaria and Raynaud’s phenomenon developed. She also had Hashimoto’s thyroiditis before.

TABLE 1

Chronic spontaneous urticaria patients followed-up in our center during SARS-CoV-2 infection and vaccination

Case #GenderAgeType and dose number of COVID-19 vaccinePostvaccine U-ASARS-CoV-2U-A during COVID-19
1F18No vaccine applicationNot caught
2F192 doses of BioNTechNoneNot caught
3M232 doses of BioNTechNoneNot caught
4M193 doses of BioNTechNoneNot caught
5F19No vaccine applicationNot caught
6F18No vaccine applicationNot caught
7F192 doses of SinovacNoneNot caught
8F202 doses of BioNTechIn both doses, mild itching and wheal occurred on the vaccina-ted arm and trunk 1 h after the vaccineCaughtNo U-A (received omalizu-mab during COVID-19)
9F15No vaccine applicationNot caught
10M142 doses of BioNTechThere was no U-A on the vaccination day but urticaria increased nearly 2 months laterNot caught
11M192 doses of BioNTechThere was no U-A on the vacci-nation day, but urticaria started 2 months laterNot caught
12F182 doses of BioNTechNoneNot caught
13F14No vaccine applicationNot caught
14F15No vaccine applicationNot caught
15F15No vaccine applicationCaughtRaynaud’s phenomenon and urticaria started after COVID-19
16M252 doses of BioNTechThere was no U-A on the vacci-nation day, but urticaria started 2 months laterNot caught

[i] M – male, F – female, U-A – urticaria and angioedema.

No adverse effect was detected in the case who took 2 doses of inactive vaccines, and he was using omalizumab at the time of administration. In 4 cases who took 2 doses of mRNA vaccines, there was also no adverse effect after vaccination (Table 1).

One case was given 2 doses of mRNA vaccines while getting omalizumab therapy. After both doses of vaccine, mild itching and wheals manifested on her arm and trunk within 1 h, accepted as an exacerbation of the disease. In the other patient with CSU, 2 doses of the mRNA vaccines were given while he was using an antihistamine, an intensification in the occurrence of urticaria (exacerbation) was detected after the vaccine, and the case was put on omalizumab management.

Two cases, without preceding urticaria, manifested urticarial plaques roughly 8 weeks after taking 2 doses of mRNA vaccines. Despite antihistamine use, urticarial plaques continued for ≥ 6 weeks, recognized as new-onset CSU cases. Since these cases did not react even to high-dose antihistamines, omalizumab was prescribed.

As a result, there was no problem with an inactivated/dead vaccine application. After mRNA vaccinations, 2 of our patients had an exacerbation of the disease and even one’s therapy had to switch to omalizumab. In 2 patients, CSU developed despite the absence of an urticaria-angioedema history (new-onset CSU) and they were also unresponsive to standard antihistamine therapy and therefore had to be started on omalizumab as well. As a result, omalizumab had to be started in 3/8 patients after mRNA vaccinations due to CSU exacerbation and/or treatment failure.

DISCUSSION

The development of skin findings such as urticaria-angioedema during various viral infections is known as the manifestation of the disease [1, 2, 5]. The precise etiology of CSU is mainly unidentified, but it is supposed that reiterated stimulation of the dermal mast cell results in the discharge of vasoactive chemical substances [1]. The development of urticaria and Raynaud’s phenomenon was observed in one of our patients after being infected with SARS-CoV-2. Conversion to systemic sclerosis has also been previously reported in some cases that developed Raynaud’s phenomenon in the literature [6].

A study by Lascialfari et al. used telemedicine for the follow-up of CSU patients. 4/26 (19.2%) cases who had COVID-19 manifested with CSU recurrence, while 1 (3.8%) had a CSU worsening/deterioration. Meanwhile, 1/26 (3.8%) vaccinated patient had a recurrence of CSU, and 1 (3.8%) had a deterioration of CSU course [7].

The CSU case series after COVID-19 vaccination was earlier defined in the literature [3, 4, 8]. For instance, Magen et al. proposed that the mRNA vaccine triggered or caused CSU to exacerbate in cases with allergic disorders and/or pre-existing autoimmunity [9]. In our study, the mRNA vaccine application resulted in new-onset CSU in 2 cases and exacerbation/relapse in 2 cases.

Anti-SARS-CoV-2 vaccine-mediated CSU has been mostly demonstrated in several single-case reports [10, 11]. Similar to the South African case series [12], Ben-Fredj et al. described a retrospective series of 10 cases who developed CSU after SARS-CoV-2 vaccination. The improvement of the eruption was seen at least 2 months afterwards, despite the regular use of a high dose of first-generation H1 antihistamine in 9 cases. Among the included patients, 6 mRNA+2 inactive/dead + 2 vector vaccines were received, and 9 patients presented with a new-onset skin reaction; nevertheless, it was a reactivation of preexisting urticaria in one of them [13]. Similar to the literature data, the mRNA vaccine was the most blamed COVID-19 vaccine, followed by the vector and inactivated vaccines [1013]. In a Turkish study, 181 (77 inactive, 104 mRNA) patients were vaccinated. Urticarial exacerbation occurred in 25/181 (13.8%) patients [14].

It is known that omalizumab can be used in the treatment of these CSU patients and that this treatment is safe [1518]. Even long-term “real-life” omalizumab therapy in children seems to be well tolerated. Its safety and efficacy profile makes omalizumab a superb substitute in severe asthma and CSU patients during childhood [19].

CONCLUSIONS

It is good to see that it is mostly safe to administer inactivated and/or mRNA vaccines in CSU patients. In addition, we have also observed that catching SARS-CoV-2 infection and vaccination does not always lead to disease exacerbation or activation. It should be kept in mind that in some patients, COVID-19 vaccination may exacerbate or trigger the new onset disease as well.

FUNDING

No external funding.

ETHICAL APPROVAL

Approval number: E-71522473-050.01.04-259122-292.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

References

1 

Giménez-Arnau AM, DeMontojoye L, Asero R, et al. The pathogenesis of chronic spontaneous urticaria: the role of infiltrating cells. J Allergy Clin Immunol Pract 2021; 9: 2195-208.

2 

Özdemir Ö, Yılmaz EA, Engin MMN. An infant with COVID-19 presenting with acute urticaria and angioedema. Int J Dermatol 2021; 60: e471-2.

3 

Özdemir Ö. Delayed nonlocal cutaneous reactions after inactive COVID-19 vaccinations. J Cosmet Dermatol 2022; 21: 6574.

4 

Özdemir Ö. Might chronic spontaneous urticaria develop after SARS-CoV-2 vaccinations? Eur J Clin Pharmacol 2023; 79: 1279-80.

5 

Muntean IA, Pintea I, Bocsan IC, et al. COVID-19 disease leading to chronic spontaneous urticaria exacerbation: a Romanian retrospective study. Healthcare 2021; 9: 1144.

6 

Giuggioli D, Spinella A, de Pinto M, et al. From Raynaud phenomenon to systemic sclerosis in COVID-19: a case report. Adv Skin Wound Care 2022; 35: 123-4.

7 

Lascialfari G, Sarti L, Barni S, et al. Relapse or worsening of chronic spontaneous urticaria during SARS-CoV-2 infection and vaccination in children: a telemedicine follow-up. Allergol Immunopathol 2022; 50: 1-7.

8 

Özdemir Ö. Chronic spontaneous urticaria after COVID-19 vaccination. Therapie 2024: S0040-5957(24)00007-6. doi: 10.1016/j.therap.2023.06.007.

9 

Magen E, Yakov A, Green I, et al. Chronic spontaneous urticaria. Asthma Proc 2022; 43: 30-6.

10 

Alflen C, Birch K, Shilian R, et al. Two cases of well controlled chronic spontaneous urticaria triggered by the moderna COVID-19 vaccine. Allergy Rhinol 2021; 12: 21526567211026271.

11 

Thomas J, Thomas G, Chatim A, et al. Chronic spontaneous urticaria after COVID-19 vaccine. Cureus 2021; 13: e18102.

12 

Craffert V, Day C, Peter J. New-onset chronic spontaneous urticaria post-COVID-19 vaccination-South African case series. J Allergy Clin Immunol Glob 2023; 2: 100154.

13 

Ben-Fredj N, Chahed F, Ben-Fadhel N, et al. Case series of chronic spontaneous urticaria following COVID-19 vaccines: an unusual skin manifestation. Eur J Clin Pharmacol 2022; 78: 1959-64.

14 

Kartal D, Orujova S, Ertaş R. Clinical effects of COVID-19 vaccines on chronic spontaneous urticaria patients: a study on two Turkish centers. Front Med 2023; 10: 1222126.

15 

Özdemir Ö, Dikici Ü. Safely use of omalizumab during SARS-CoV-2 infection in patients with chronic spontaneous urticaria. J Cosmet Dermatol 2023; 22: 26-7.

16 

Yildirim SK, Ogut ND, Erbagci E. Retrospective evaluation of patients with chronic spontaneous urticaria using omalizumab during COVID-19 pandemic. J Cosmet Dermatol 2022; 21: 431-4

17 

Sayaca N, Cansız KA, Yıldırım E, et al. The effect of COVID-19 on patients recieving omalizumab treatment. Rev Fr Allergol 2023; 63: 103281.

18 

Atayik E, Aytekin G. The course of COVID-19 in patients with chronic spontaneous urticaria receiving omalizumab treatment. Rev Fr Allergol 2022; 62: 684-8.

19 

Galletta F, Caminiti L, Lugarà C, et al. Long-term safety of omalizumab in children with asthma and/or chronic spontaneous urticaria: a 4-year prospective study in real life. J Pers Med 2023; 13: 1068.

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