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2.
Eur J Clin Pharmacol ; 78(12): 1959-1964, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2075334

ABSTRACT

BACKGROUND: Urticaria following the COVID-19 vaccine was rarely reported and had a short self-limited resolution. However, there has been relatively little literature published on CSU induced by COVID-19 vaccines. PURPOSE: We describe a case series of patients who experienced CSU after SARS-CoV-2 vaccination. METHODS: A retrospective case series of 10 patients referred to the Department of Clinical Pharmacology of the University of Monastir (January 2021-January 2022) and included for evaluation of urticaria after COVID-19 vaccination. RESULTS: The median age was 31 years and patients were mostly female. Atopy was presented in 3 patients and urticaria was accompanied by angioedema in 6 patients. The median time interval between vaccination and the onset of urticaria was 28.5 h. The offended dose was the first one in 8 patients. The resolution of the eruption was observed at least 2 months later, despite the regular use of a full dose of antihistamine in nine patients. Polynuclear leucocytosis was identified in 5 patients. Anti-TPOAb was positive in one patient after receiving the BNT162b2 vaccine. Total serum IgE was elevated in 4 patients. Skin tests for the suspected vaccine as well as the vaccine excipient were negative. CONCLUSION: We add to the medical literature ten new cases of chronic spontaneous urticarial reactions following COVID-19 vaccines uncontrolled with high-dose first-generation H1 antihistamines.


Subject(s)
COVID-19 Vaccines , COVID-19 , Chronic Urticaria , Urticaria , Adult , Female , Humans , Male , BNT162 Vaccine , Chronic Disease , Chronic Urticaria/etiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Histamine H1 Antagonists/adverse effects , Retrospective Studies , SARS-CoV-2 , Urticaria/chemically induced
3.
Allergol Immunopathol (Madr) ; 50(S Pt 1): 17-29, 2022.
Article in English | MEDLINE | ID: covidwho-2067381

ABSTRACT

Urticaria diagnosis may be challenging in children since it can be triggered or related to numerous conditions. In this paper, we reviewed the main aspects regarding the diagnosis of urticaria in the pediatric population. Acute urticaria is often due to viral infections. However, other culprits, including foods, insect stings, drugs, contrast media, vaccination, latex, and medical diseases, may account for acute patterns. Laboratory tests and confirmatory allergy tests should be individualized and guided by history. Chronic urticaria (CU) is defined when hives and/or angioedema last for more than 6 weeks. The most common type of chronic urticaria in children is chronic spontaneous urticaria (CSU). Chronic inducible urticaria (CindU) is less common but is important to diagnose in order to manage appropriately and reduce the risk of severe reactions. Inducible forms in children are often diagnosed with specific provocation tests similar to the tests used in adults. Given that chronic urticaria could rarely be a presentation of vasculitis, systemic-onset juvenile idiopathic arthritis, or auto-inflammatory syndromes, it is important to rule out these conditions. It is crucial to differentiate cases of chronic urticaria from mastocytosis and Bradykinin-mediated angioedema, given that treatment may differ. The management of chronic urticaria in children has improved over the last decade because of the development of both clear management guidelines and new effective drugs. It is crucial to increase awareness for appropriate diagnosis and new available treatment to improve the management of chronic urticaria in children.


Subject(s)
Angioedema , Chronic Urticaria , Urticaria , Adolescent , Adult , Angioedema/diagnosis , Child , Chronic Disease , Humans , Urticaria/drug therapy
5.
Allergol Immunopathol (Madr) ; 50(S Pt 2): 1-7, 2022.
Article in English | MEDLINE | ID: covidwho-2056550

ABSTRACT

BACKGROUND: Chronic urticaria (CU), characterized by daily wheals and/or angioedema lasting more than 6 weeks, is a common skin disease. CU is classified as spontaneous or inducible. Because of Coronavirus Disease-19 (COVID-19) pandemic, face-to-face visits were reduced, and many centers started remote consultations to minimize hospital admissions and risk for viral diffusion. Telemedicine became a valuable tool for evaluating and monitoring patients with chronic diseases, such as CU. This study aims to evaluate the effectiveness of telemedicine as a means for the follow-up of patients with chronic spontaneous urticaria (CSU) during the COVID-19 pandemic. In particular, we collected data related to CSU evolution and treatment by remote consultation. Moreover, we specifically investigated the impact of SARS-CoV-2 infection or vaccination on CSU in relapsing or worsening of such a disease. METHODS: The electronic charts were reviewed for patients diagnosed with CSU, who were referred to the allergy unit of Meyer Children's Hospital, Florence. For each patient, a review of demographic characteristics, diagnostic workup, efficacy, and tolerability of the treatment was performed. Patients with a physical agent triggering CU were excluded from the study. Disease activity was monitored using the Urticaria Activity Score (UAS7). In addition, when the COVID-19 pandemic started, follow-up continued through telemedicine after an initial face-to-face visit when possible. Approximately 1 year after the diagnosis of CSU, patients were recontacted to investigate whether they had experienced a relapse or worsening of urticaria during a possible COVID-19 or immediately after receiving a COVID-19 vaccine. RESULTS: From January 2020 to March 2021, 84 cases of CSU were identified, with 71 (84.5%) of these being evaluated via televisit (remote consultation). During the remote follow-up period, 38/71 (53.5%) patients who were evaluated via televisit recovered completely from CSU, while 24 (33.8%) made therapy adjustments, and 9 (12.7%) had to discontinue follow-up through remote visits and return to face-to-face visits. In February 2022, we recontacted the 71 patients with CSU, and 50 (70.4%) of them answered by phone call interview. Four (19.2%) of the 26 patients who had COVID-19 showed CSU relapse, while 1 (3.8%) had a CSU worsening. Instead, 1 (3.8%) patient of the 26 who were vaccinated had a relapse of CSU, and 1 (3.8%) had a worsening of CSU, both after the first dose. CONCLUSION: Our data showed that telemedicine can be an effective tool for the follow-up of patients with CSU. Moreover, COVID-19, as well as COVID-19 vaccination, may trigger CSU relapse or worsening, but both are unspecific triggers, and urticaria shows a very short duration in most cases.


Subject(s)
COVID-19 Vaccines , COVID-19 , Chronic Urticaria , Telemedicine , Urticaria , COVID-19/complications , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Child , Chronic Disease , Copper/therapeutic use , Follow-Up Studies , Humans , Pandemics , Recurrence , SARS-CoV-2
6.
Tuberk Toraks ; 70(3): 231-241, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2056109

ABSTRACT

Introduction: To assess the incidence and course of COVID-19 in patients with severe asthma/chronic spontaneous urticaria using biological agents. Materials and Methods: A total of 202 patients (142 with asthma, and 60 with urticaria) were enrolled. The subjects were asked via face-to-face or telephone interview whether they had been diagnosed with COVID-19 and the course of the disease. Result: Study group consisted of 132 women, and 70 men (median age= 48 years). Median omalizumab dose was 300 mg/month in asthma (min-max= 150-1200 mg). The mepolizumab dose of two patients diagnosed with EGPA was 300 mg/month. Thirty one (15.3%) patients were diagnosed with COVID-19, 22 (71%) of whom were receiving omalizumab and nine (29%) were receiving mepolizumab. Asthma or chronic spontaneous urticaria diagnosis, age, sex, smoking, weight, comorbidities, atopy, and biological agent use were not statistically different between patients with or without COVID-19. Nine COVID-19 patients were hospitalized, and three of them required intensive care. Mepolizumab usage was higher in hospitalized patients (5, 55.6%), whereas omalizumab usage was higher in home-treated patients (18, 81%). The mean duration of biological use in home-treated patients was significantly higher than that of the hospitalized patients (35.64 months vs. 22.56 months, p= 0.024). Biological treatment was interrupted in 47 (23%) patients, selfinterruption due to the infection risk was the foremost reason (34%). Conclusions: The incidence of COVID-19 among patients with asthma and urticaria on mepolizumab and omalizumab was higher compared to studies from other countries. The disease course appeared mild in patients receiving long-term biological therapy.


Subject(s)
Anti-Asthmatic Agents , Asthma , COVID-19 , Chronic Urticaria , Pulmonary Eosinophilia , Urticaria , Anti-Asthmatic Agents/adverse effects , Antibodies, Monoclonal, Humanized , Asthma/drug therapy , Asthma/epidemiology , Biological Factors/therapeutic use , COVID-19/drug therapy , COVID-19/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Omalizumab/therapeutic use , Pulmonary Eosinophilia/drug therapy , Urticaria/chemically induced , Urticaria/drug therapy , Urticaria/epidemiology
7.
J Allergy Clin Immunol Pract ; 10(10): 2734-2741.e7, 2022 10.
Article in English | MEDLINE | ID: covidwho-2049379

ABSTRACT

BACKGROUND: Urticarial vasculitis (UV) is a rare and difficult-to-treat chronic skin disease defined by long-lasting urticarial lesions and the histopathologic finding of leukocytoclastic vasculitis. As of yet, little is known about UV patients' perspective on the disease. OBJECTIVE: To assess UV patients' perspective on the clinical course, treatment response, greatest challenges, and quality-of-life (QOL) impairment. METHODS: A web-based questionnaire was disseminated in a Facebook group of patients with UV. Patients with UV confirmed by skin biopsy were included. RESULTS: Patients with UV had a mean age of 47.3 ± 12.3 years and were mostly female (94.3%; n = 82 of 87). The median delay in diagnosis was 8.1 months (interquartile range, 2.0-46.3). Normocomplementemia and hypocomplementemia were present in 54.0% (n = 27) and 46.0% (n = 23) of 50 patients, respectively. Most patients with UV (51.8%; n = 43 of 83) reported severely decreased QOL due to their disease. Low QOL was also the most frequently reported greatest challenge for patients with UV (40.7%), followed by the long-standing course of UV with frequent relapses (14.8%). Low QOL correlated with long disease duration (r = 0.298; P = .02) and high numbers of clinical symptoms (r = 0.294; P = .007). Patients with UV with allergies, lung diseases, and chronic infections reported lower QOL. Patients with UV with low QOL were treated with analgesics, dapsone, montelukast, omalizumab, and colchicine more often than patients with UV with higher QOL (P < .05 for all). CONCLUSIONS: Our results show a considerable impairment in QOL in patients with UV associated with long disease duration, high symptom burden, and a high need for therapy. Improvement of the management of UV by further research is necessary.


Subject(s)
Urticaria , Vasculitis, Leukocytoclastic, Cutaneous , Adult , Colchicine , Dapsone/therapeutic use , Female , Humans , Male , Middle Aged , Omalizumab/therapeutic use , Patient Reported Outcome Measures , Quality of Life , Urticaria/diagnosis , Urticaria/drug therapy , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
8.
Dermatol Ther ; 35(11): e15838, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2029319

ABSTRACT

Urticaria is a disease characterized by wheals and/or angioedema. Chronic spontaneous urticaria (CSU) occurs for longer than 6 weeks and appears independently of any identifiable exogenous stimulus. During the vaccination campaign for Coronavirus disease 2019 (COVID-19) pandemic, several cutaneous adverse events have been described, among which urticaria lasting less than 6 weeks (acute urticaria, AU). AU due to vaccines can be IgE or non-IgE mediated; the former typically develop within 4 h of drug exposure, the latter occurs later and the mechanism is unclear. In this retrospective study we analyzed the frequency and clinical characteristics of urticaria occurring after COVID-19 vaccine (post-vaccination urticaria relapse) in adult CSU patients treated with antihistamine and omalizumab, and in clinical remission.


Subject(s)
Anti-Allergic Agents , COVID-19 , Chronic Urticaria , Urticaria , Adult , Humans , Omalizumab/adverse effects , Chronic Urticaria/drug therapy , COVID-19 Vaccines/adverse effects , Retrospective Studies , RNA, Messenger , Anti-Allergic Agents/adverse effects , Urticaria/etiology , Urticaria/chemically induced , Histamine Antagonists/adverse effects , Chronic Disease , Recurrence , Treatment Outcome
11.
Am J Clin Dermatol ; 23(5): 729-737, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1982398

ABSTRACT

OBJECTIVES: Adverse reactions to the COVID-19 vaccines have been of interest since their emergency authorization. Cutaneous manifestations of the vaccines are not well studied. We aimed to characterize cutaneous reactions to the Moderna (mRNA-1273) and the Pfizer-BioNTech (BNT162b2) COVID-19 vaccines on a large, national scale. METHODS: The Vaccine Adverse Event Reporting System was filtered for cutaneous and hair and nail reactions to the COVID-19 vaccines. Patient demographics and past medical histories, vaccine manufacturer and dosing, symptom timing, reaction location, and patient outcomes were extracted from each report. RESULTS: As of December 24, 2021, there were 67,273 cutaneous reactions to all COVID-19 vaccines, with most patients receiving the Moderna (mRNA-1273) or Pfizer-BioNTech (BNT162b2) vaccines. The most common reactions overall were injection-site reaction, urticaria, and papular rash, with injection-site reaction more common after the Moderna (mRNA-1273) vaccine, and all other cutaneous reactions more common after the Pfizer-BioNTech (BNT162b2) vaccine. Patients with past histories of psoriasis, urticaria, and local site reactions to a vaccine were more likely to report these same symptoms after the COVID-19 vaccine. CONCLUSION: Patients should be counseled about these potential dermatologic reactions to the COVID-19 vaccines. Most occur within the first few days after vaccination, and are mild and self-limiting. Patients should therefore be encouraged that it is safe to receive the COVID-19 vaccine from a dermatological perspective.


Subject(s)
COVID-19 Vaccines , COVID-19 , Urticaria , Vaccines , 2019-nCoV Vaccine mRNA-1273 , Adverse Drug Reaction Reporting Systems , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Vaccination Hesitancy , Vaccines/adverse effects
12.
J Cosmet Dermatol ; 21(9): 3667-3672, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1956775

ABSTRACT

BACKGROUND: COVID-19 has been linked to a variety of dermatological conditions. OBJECTIVE: To determine the presence of various cutaneous manifestations in patients with COVID-19, also to define their features in relation to the systemic symptoms. METHODS: This research enrolled a total of 1206 lab-confirmed COVID-19 individuals at a tertiary-care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID-related skin conditions. COVID-19 severity was categorized as asymptomatic/mild, moderate, or severe. RESULTS: Of the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculopapular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer-lasting vascular pattern was related with an older age and a fatal COVID-19 outcomes (P: 0.000) compared with mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared with moderate/severe infection. LIMITATIONS: Single-Center and observational study. CONCLUSION: Vascular lesions were correlated with disastrous COVID-19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, while the urticarial rash was linked to milder course compared with moderate/severe severity infection.


Subject(s)
COVID-19 , Drug Eruptions , Exanthema , Purpura , Urticaria , COVID-19/complications , Exanthema/diagnosis , Exanthema/etiology , Humans , SARS-CoV-2 , Urticaria/etiology
13.
Expert Rev Clin Immunol ; 18(9): 889-899, 2022 09.
Article in English | MEDLINE | ID: covidwho-1931586

ABSTRACT

INTRODUCTION: Chronic urticaria (CU) appears with daily or intermittent/recurrent wheals with/without angioedema for more than six weeks. When no specific eliciting factors are found, chronic urticaria is defined as spontaneous (CSU). Up to 50% of patients with CSU do not respond to therapy, leading to a prolonged disease course and the need for expensive therapies, impacting the quality of life (QoL) and healthcare resources. AREAS COVERED: Diagnosis of CSU is made when other potential causes of chronic urticaria are excluded. CSU therapy aims to achieve complete control of symptoms and normalization of QoL. Current treatment options for urticaria aim to target mast cell mediators such as histamine, or activators, such as autoantibodies. Guidelines recommend starting with second generation antihistamines (sgAHs) and adding omalizumab therapy if symptoms are not controlled. This review aims to provide a practical guide for CSU in the pediatric population. EXPERT OPINION: Treatment options for pediatric CSU are primarily based on adult data that have been extrapolated for children. Current guidelines should be reevaluated based on pediatric data, new biological treatments, and the COVID-19 pandemic. Future research is needed to investigate strategies to personalize current treatments and identify potential predictive biomarkers.


Subject(s)
Anti-Allergic Agents , COVID-19 , Chronic Urticaria , Omalizumab , Urticaria , Adult , Anti-Allergic Agents/therapeutic use , Child , Chronic Disease , Chronic Urticaria/diagnosis , Chronic Urticaria/therapy , Humans , Omalizumab/therapeutic use , Pandemics , Quality of Life , Urticaria/drug therapy , Urticaria/therapy
14.
J Cosmet Dermatol ; 21(9): 3692-3703, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1916201

ABSTRACT

OBJECTIVES: In this study covering all of Turkey, we aimed to define cutaneous and systemic adverse reactions in our patient population after COVID-19 vaccination with the Sinovac/CoronaVac (inactivated SARS-CoV-2) and Pfizer/BioNTech (BNT162b2) vaccines. METHODS: This prospective, cross-sectional study included individuals presenting to the dermatology or emergency outpatient clinics of a total of 19 centers after having been vaccinated with the COVID-19 vaccines. Systemic, local injection site, and non-local cutaneous reactions after vaccination were identified, and their rates were determined. RESULTS: Of the 2290 individuals vaccinated between April 15 and July 15, 2021, 2097 (91.6%) received the CoronaVac vaccine and 183 (8%) BioNTech. Systemic reactions were observed at a rate of 31.0% after the first CoronaVac dose, 31.1% after the second CoronaVac dose, 46.4% after the first BioNTech dose, and 46.2% after the second BioNTech dose. Local injection site reactions were detected at a rate of 35.6% after the first CoronaVac dose, 35.7% after the second CoronaVac dose, 86.9% after the first BioNTech dose, and 94.1% after the second BioNTech dose. A total of 133 non-local cutaneous reactions were identified after the CoronaVac vaccine (2.9% after the first dose and 3.5% after the second dose), with the most common being urticaria/angioedema, pityriasis rosea, herpes zoster, and maculopapular rash. After BioNTech, 39 non-local cutaneous reactions were observed to have developed (24.8% after the first dose and 5% after the second dose), and the most common were herpes zoster, delayed large local reaction, pityriasis rosea, and urticaria/angioedema in order of frequency. Existing autoimmune diseases were triggered in 2.1% of the patients vaccinated with CoronaVac and 8.2% of those vaccinated with BioNTech. CONCLUSIONS: There are no comprehensive data on cutaneous adverse reactions specific to the CoronaVac vaccine. We determined the frequency of adverse reactions from the dermatologist's point of view after CoronaVac and BioNTech vaccination and identified a wide spectrum of non-local cutaneous reactions. Our data show that CoronaVac is associated with less harmful reactions while BioNTech may result in more serious reactions, such as herpes zoster, anaphylaxis, and triggering of autoimmunity. However, most of these reactions were self-limiting or required little therapeutic intervention.


Subject(s)
Angioedema , COVID-19 , Herpes Zoster , Pityriasis Rosea , Urticaria , Vaccines , Angioedema/chemically induced , BNT162 Vaccine , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Cross-Sectional Studies , Herpes Zoster/chemically induced , Herpes Zoster/prevention & control , Herpesvirus 3, Human , Humans , Pityriasis Rosea/chemically induced , Prospective Studies , SARS-CoV-2 , Turkey/epidemiology , Urticaria/chemically induced , Vaccination/adverse effects , Vaccines/adverse effects
16.
Acta Dermatovenerol Alp Pannonica Adriat ; 31(2): 71-73, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1904952

ABSTRACT

The COVID-19 pandemic has changed many areas of life, including habits and trends in dermatological practice and dermatology patients' lifestyles. This article presents cases of patients infected with COVID-19, patients that developed lesions due to pandemic-related public health measures affecting the skin, and those that developed skin lesions after COVID-19 vaccination. One case concerned a female patient with widespread urticaria that had repeatedly gone to emergency rooms and had been administered corticosteroids and antihistamines for an undiagnosed COVID-19 infection that had been triggering her urticaria outbreaks. Another patient complained of urticaria outbreaks and was examined and treated multiple times at emergency rooms until a dermatological follow-up determined he was suffering from dysmorphophobia. Among those with lesions due to frequent hygiene during the pandemic, we examined a female with contact dermatitis triggered by repeated and prolonged contact with hand disinfectant. Another patient presented with a phototoxic reaction on the neck after using hand disinfectant. In addition, we saw widespread lesions on a patient that reported recently being vaccinated against COVID-19. Finally, in an effort to prevent COVID-19 transmission, we believe that a first-time onset of non-specific exanthema indicates COVID-19 testing because it may be an early indicator of viral infection.


Subject(s)
COVID-19 , Hand Sanitizers , Skin Diseases , Urticaria , COVID-19 Testing , COVID-19 Vaccines , Female , Humans , Male , Pandemics/prevention & control , Skin Diseases/etiology
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