Urticaria after SARS-CoV-2 vaccination.

Background: Infections are considered the most common known trigger of acute urticaria. Vaccinations can mimic infections and are also able to trigger urticaria. Method(s): This paper describes four exemplary patients with urticaria after SARSCoV-2 vaccination and discusses the occurrence of this adverse event with recent findings from the literature. Result(s): After SARS-CoV-2 vaccination, both acute (case 1) and chronic spontaneous urticaria (CSU) may occur for the first time (case 2) but a stable well-adjusted CSU may also worsen (case 3) or a pre-existing CSU may recur (case 4). The underlying pathomechanisms are not fully elucidated but activation of the immune system by vaccination seems plausible, similar to infection-triggered urticaria. Subsequent vaccinations are recommended even in the presence of a positive history of urticaria after SARS-CoV-2 vaccination and is often well tolerated;prophylactic administration of antihistamines should be considered. Allergy to vaccine components such as polyethylene glycol (PEG), which can lead to anaphylaxis, is comparatively rare. In cases of urticaria after SARS-CoV-2 vaccination, an accurate history allows risk assessment and provides the indication for further allergy diagnostic workup. Conclusion(s): Various forms of urticaria are a relatively common cutaneous side effect of SARS-CoV-2 vaccination in cases of pre-existing predisposition. They are not a contraindication to further vaccination. There is no need for further allergy diagnosis in the majority of cases.Copyright ©2023 Dustri-Verlag Dr. K. Feistle.

Increasing the COVID-19 immunization rate through allergy testing.

BACKGROUND: Vaccination of the population is required to combat the COVID-19 pandemic. Allergy testing could reduce anxiety towards COVID-19 vaccination and thereby may increase vaccination rate, however, its effectiveness remains unclear. METHODS: One hundred and thirty prospective real-life patients in need of but not daring to get vaccinated asked for allergy workup for COVID-19 vaccine hypersensitivity in 2021/2022. Characterization of patients, identification of anxieties, decrease of patient's anxiety levels, overall vaccination rate and adverse reactions after vaccination were assessed. RESULTS: Tested patients were characterized by being female (91.5%) and having a high rate of previous allergies (e.g. to food 55.4%, drugs 54.6%, or previous vaccinations 50%) and dermatological disease (29.2%) but not always had medical contraindications for COVID-19 vaccination. Sixty one patients (49.6%) were highly concerned (4-6, Likert scale 0-6) about vaccination and 47 (37.6%) expressed resolving thoughts about vaccinaion anaphylaxis (3-6, Likert scale 0-6). However only 35 patients (28.5%) were scared of getting COVID-19 within 2 months (4-6, Likert scale 0-6) and only 11 (9%) patients had high expectations of getting COVID-19 (4-6, Likert scale 0-6). Allergy testing significantly (p < 0.01 to p < 0.05 respectively) reduced the median anxiety of allergic symptoms following vaccination: dyspnoea (4.2-3.1), to faint (3.7-2.7), long-term consequences (3.6-2.2), pruritus (3.4-2.6), skin rash (3.3-2.6) and death (3.2-2.6). After allergy testing, most patients (108/122, 88.5%) let themselves be vaccinated within 60 days. Revaccinated patients with previous symptoms experienced a reduction of symptoms (p < 0.05) upon revaccination. CONCLUSIONS: Patients not daring to get vaccinated have more anxiety towards vaccination than to acquire COVID-19. For those, allergy testing excludes vaccine allergy, and is a tool to increase vaccination willingness and thereby helps to combat vaccination hesitancy.

Urtikaria nach SARS-CoV-2-Impfung

Hintergrund: Infektionen sind die häufigsten nachgewiesenen Auslöser von akuter Urtikaria. Impfungen können Infektionen imitieren und ebenfalls Urtikaria auslösen. Methodik: In dieser Arbeit werden beispielhaft vier Patienten mit Urtikaria nach SARS-CoV-2-Impfung beschrieben und das Auftreten dieser Nebenwirkung mit Erkenntnissen aus der Literatur diskutiert. Ergebnisse: Nach SARS-CoV-2-Impfung kann sowohl eine akute (Fall 1) als auch chronische spontane Urtikaria (CSU) erstmalig auftreten (Fall 2), aber es kann sich auch eine gut eingestellte CSU verschlechtern (Fall 3) oder eine vorbekannte CSU wieder auftreten (Fall 4). Der zugrundeliegende Pathomechanismus ist noch nicht vollständig verstanden, jedoch erscheint eine Aktivierung des Immunsystems durch die Impfung, ähnlich wie bei einer infektgetriggerten Urtikaria, plausibel. Die Folgeimpfung wird auch bei einer positiven Anamnese hinsichtlich einer Urtikaria nach SARS-CoV-2-Impfung in der Vorgeschichte empfohlen und oftmals gut toleriert, dafür sollte eine prophylaktische Gabe von Antihistaminika erwogen werden. Eine Allergie auf einen Impfstoffbestandteil wie Polyethylenglykol (PEG), welche bis zu einer Anaphylaxie führen kann, ist vergleichsweise selten. Bei Urtikaria nach SARS-CoV-2-Impfung erlaubt eine genaue Anamnese die Risikoabschätzung und stellt die Indikation für weitere allergologische Diagnostik. Schlussfolgerung: Urtikaria ist eine relativ häufige kutane Nebenwirkung der SARS-CoV-2-Impfung bei vorbestehender Prädisposition und kann unterschiedliche Verläufe zeigen. Sie stellt keine Kontraindikation für weitere Impfungen dar. Die Notwendigkeit weiterer Allergiediagnostik besteht in der Mehrzahl der Fälle nicht.

Allergological clarification of suspected COVID-19 vaccine allergy in the Christmas week 2021: organization and findings of a pilot study

Background: In 2020 the COVID-19 pandemic spread due to the coronavirus SARS-CoV-2. Vaccination is crucial to fight the COVID-19 pandemic. Initial reports of anaphylaxis after vaccination caused concern and fear of the population and consequently a high demand for allergy testing. Method(s): The need and reasons for allergy testing were recorded via questionnaires and the patients' medical history. To study the possibility of higher-throughput allergy evaluation, additional new skin test appointment slots were created for patients concentrated during the Christmas week 2021 and the amount of material, time required, as well as the organization and the tolerability of subsequent vaccination were analyzed. Result(s): The demand for testing greatly exceeded the number of available standard appointment slots. Test indications were mostly the patients' fear of an allergic reaction to the vaccine when a polyethylene glycol (PEG) allergy could not be unequivocally excluded in the patients' history. Forty-one patients (38 females, 3 men, age 51 +/- 17.7) were tested on 3 days. The average contact time needed per patients for the nurse was 30 minutes and for the physician 25 minutes. One patient could not be tested due to antihistamine use. After testing, in 36 cases routine vaccination was recommended;of those 35 patients got vaccinated. In four patients, an indication for inpatient PEG provocation or inpatient vaccination was given. Two thirds (27/41 patients, 65.9%) of all who were initially refusing vaccination got vaccinated shortly after allergy tests and tolerated this vaccination without major complications, an additional 9.8% intended future vaccination. Only four patients (9.8%) persistently refused vaccination after testing. Conclusion(s): In this pilot study, we show a useful and effective option to triage patients requesting COVID-19 vaccine allergy testing and generally how to process allergy appointments in a more time effective manner. Optimizing intraclinical processes leads to a substantially higher number of patients that can be allergy tested and vaccinated. Copyright © 2022 Dustri-Verlag Dr. K. Feistle.