ABSTRACT
Background: Delayed local reactions due to mRNA vaccines or COVID arm have been reported. COVID arm commonly presents as an itchy and painful erythematous plaque with swelling and is characterized by a delayed onset of 7 to 10 days after vaccination. New excipients used in mRNA vaccines (polyethylene glycol (PEG)-2000, tromethamol and 1,2-distearoyl-sn-glicero-3-phosphocholine) have increased the awareness about their role in such cutaneous adverse reactions. Objectives: To define the excipient accountability in COVID arm through specific skin provocation testing. Methods: Health workers of a tertiary level hospital suffering COVID arm were patch, skin prick (SP) and intradermal (ID) tested with PEG-400, PEG-2000, tromethamol and 3-phosphocholine at different concentrations (0.001%, 0.01%, 0.1% and 1%). Positive long standing ID reactions were biopsied. Results: Eleven patients were included. Patch tests were always negative. PEG-2000 presented positive SP at 1% (4 patients) and 0.1% (1 patient). PEG-2000 ID was positive at 1% (10 patients), 0.1% (7 patients) and 0.01% (6 patients). Three showed long standing positive reactions to ID of PEG-2000 on day 2, whose biopsies depicted perivascular lymphocytes, occasional eosinophils and dermal edema. In addition, 6 patients reacted to PEG-400, all of which also reacted to PEG-2000. SP and ID for the other excipients were negative. Conclusions: The presence of immediate and delayed reactions to PEG-2000 in patients. with COVID arm poses a challenge on whether PEG-2000 acts as a delayed sensitizer or. these infrequent reactions are irritative.
Subject(s)
COVID-19 , Psoriasis , COVID-19 Vaccines , Humans , Psoriasis/genetics , RNA, Messenger , SARS-CoV-2ABSTRACT
BACKGROUND: Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. OBJECTIVE: To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. METHODS: A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. RESULTS: From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site ('COVID arm', 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. CONCLUSIONS: Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.