Cutaneous reactions following COVID-19 vaccination assessed by dermatologists: a single-institutional study in Germany.
COVID-19 vaccination
cutaneous reactions
hypersensitivity reactions
urticaria
Journal
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
ISSN: 1610-0387
Titre abrégé: J Dtsch Dermatol Ges
Pays: Germany
ID NLM: 101164708
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
07
10
2022
accepted:
04
12
2022
pubmed:
10
3
2023
medline:
22
3
2023
entrez:
9
3
2023
Statut:
ppublish
Résumé
Cutaneous reactions following COVID-19 vaccination have been frequently described, whereas larger case series by dermatologists are lacking. This study assesses SARS-CoV-2 vaccination-associated skin reactions, severity, treatment, course, eliciting vaccines, allergy test results and tolerance to revaccination. Single-institutional, non-interventional study of dermatologists assessing cutaneous manifestations in 83 patients in Germany. 93 reactions were presented. Manifestations clustered into immediate (n = 51, 54.8%) and delayed hypersensitivity reactions (n = 10, 10.8%), chronic inflammatory skin diseases (n = 13, 14.0%), reactivation of latent herpes virus infection (pityriasis rosea/herpes zoster; n = 9; 9.7%) and others (n = 10, 10.8%). Vaccination was associated with new (76.3%) - mostly hypersensitivity reactions - or exacerbation of known skin diseases (23.7%), in this case predominantly chronic inflammatory skin diseases. Reactions occurred primarily within the first week (72.8%) and after first vaccination (62.0%). Treatment was required in 83.9% and hospitalization in 19.4%. In 48.8% revaccination led to recurrence of the same reactions. Disease was ongoing at last consultation in 22.6%, primarily in chronic inflammatory skin diseases. Allergy tests were performed in 15 patients (18.1%) and resulted negative. It can be assumed that vaccination may trigger immune activation-related reactions especially in those patients predisposed to develop respective skin diseases.
Sections du résumé
BACKGROUND AND OBJECTIVES
Cutaneous reactions following COVID-19 vaccination have been frequently described, whereas larger case series by dermatologists are lacking. This study assesses SARS-CoV-2 vaccination-associated skin reactions, severity, treatment, course, eliciting vaccines, allergy test results and tolerance to revaccination.
PATIENTS AND METHODS
Single-institutional, non-interventional study of dermatologists assessing cutaneous manifestations in 83 patients in Germany.
RESULTS
93 reactions were presented. Manifestations clustered into immediate (n = 51, 54.8%) and delayed hypersensitivity reactions (n = 10, 10.8%), chronic inflammatory skin diseases (n = 13, 14.0%), reactivation of latent herpes virus infection (pityriasis rosea/herpes zoster; n = 9; 9.7%) and others (n = 10, 10.8%). Vaccination was associated with new (76.3%) - mostly hypersensitivity reactions - or exacerbation of known skin diseases (23.7%), in this case predominantly chronic inflammatory skin diseases. Reactions occurred primarily within the first week (72.8%) and after first vaccination (62.0%). Treatment was required in 83.9% and hospitalization in 19.4%. In 48.8% revaccination led to recurrence of the same reactions. Disease was ongoing at last consultation in 22.6%, primarily in chronic inflammatory skin diseases. Allergy tests were performed in 15 patients (18.1%) and resulted negative.
CONCLUSIONS
It can be assumed that vaccination may trigger immune activation-related reactions especially in those patients predisposed to develop respective skin diseases.
Substances chimiques
COVID-19 Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255-262Informations de copyright
© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.
Références
WHO. WHO Coronavirus (COVID-19) Dashboard 2022 [13.02.2022]. Available from: https://covid19.who.int/ [Last accessed December 12, 2022].
Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
Guan WJ, Ni ZY, Hu Y, et al. clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
Tomsitz D, Biedermann T, Brockow K. Skin manifestations reported in association with COVID-19 infection. J Dtsch Dermatol Ges. 2021;19(4):530-534.
Kashte S, Gulbake A, El-Amin Iii SF, Gupta A. COVID-19 vaccines: rapid development, implications, challenges and future prospects. Hum Cell. 2021;34(3):711-733.
Sun Q, Fathy R, McMahon DE, Freeman EE. COVID-19 Vaccines and the skin: The landscape of cutaneous vaccine reactions worldwide. Dermatol Clin. 2021;39(4):653-673.
Gambichler T, Boms S, Susok L, et al. Cutaneous findings following COVID-19 vaccination: review of world literature and own experience. J Eur Acad Dermatol Venereol. 2022;36(2):172-180.
Brockow K, Mathes S, Fischer J, et al. Experience with polyethylene glycol allergy-guided risk management for COVID-19 vaccine anaphylaxis. Allergy. 2022;77(7):2200-2210.
Qaderi K, Golezar MH, Mardani A, et al. Cutaneous adverse reactions of COVID-19 vaccines: A systematic review. Dermatol Ther. 2022;35(5):e15391.
Tan SW, Tam YC, Pang SM. Cutaneous reactions to COVID-19 vaccines: A review. JAAD Int. 2022;7:178-186.
McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46-55.
McMahon DE, Kovarik CL, Damsky W, et al. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study. J Am Acad Dermatol. 2022;86(1):113-121.
Robinson LB, Fu X, Hashimoto D, et al. Incidence of cutaneous reactions after messenger RNA COVID-19 vaccines. JAMA Dermatol. 2021;157(8):1000-1002.
Fernandez-Nieto D, Hammerle J, Fernandez-Escribano M, et al. Skin manifestations of the BNT162b2 mRNA COVID-19 vaccine in healthcare workers. ‘COVID-arm’: a clinical and histological characterization. J Eur Acad Dermatol Venereol. 2021;35(7):e425-e427.
Blumenthal KG, Freeman EE, Saff RR, et al. Delayed large local reactions to mRNA-1273 vaccine against SARS-CoV-2. N Engl J Med. 2021;384(13):1273-1277.
Johnston MS, Galan A, Watsky KL, Little AJ. delayed localized hypersensitivity reactions to the Moderna COVID-19 vaccine: A case series. JAMA Dermatol. 2021;157(6):716-720.
Bogdanov G, Bogdanov I, Kazandjieva J, Tsankov N. Cutaneous adverse effects of the available COVID-19 vaccines. Clin Dermatol. 2021;39(3):523-531.
Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine - United States, December 21, 2020-January 10, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(4):125-129.
Niebel D, Wenzel J, Wilsmann-Theis D, et al. Single-center clinico-pathological case study of 19 patients with cutaneous adverse reactions following COVID-19 vaccines. Dermatopathology (Basel). 2021;8(4):463-476.
Klein SL, Jedlicka A, Pekosz A. The Xs and Y of immune responses to viral vaccines. Lancet Infect Dis. 2010;10(5):338-349.
Chadbourne EB, Zhang S, Gordon MJ, et al. Clinical outcomes in reduction mammaplasty: a systematic review and meta-analysis of published studies. Mayo Clin Proc. 2001;76(5):503-510.
Statista. Impfungen gegen das Coronavirus nach Hersteller 2021 2022. Available from: https://de.statista.com/statistik/daten/studie/1197550/umfrage/impfungen-gegen-das-coronavirus-nach-hersteller/ [Last accessed February 13, 2022].
Statista. Impfquote gegen das Coronavirus (COVID-19) in Deutschland nach Altersgruppen 2022. Available from: https://de.statista.com/statistik/daten/studie/1258043/umfrage/impfquote-gegen-das-coronavirus-in-deutschland-nach-altersgruppe/ [Last accessed February 13, 2022].
Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-2615.
Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403-416.
Montecino-Rodriguez E, Berent-Maoz B, Dorshkind K. Causes, consequences, and reversal of immune system aging. J Clin Invest. 2013;123(3):958-965.
Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179-186.
McElhaney JE, Dutz JP. Better influenza vaccines for older people: what will it take? J Infect Dis. 2008;198(5):632-634.
Marshall JS, Warrington R, Watson W, Kim HL. An introduction to immunology and immunopathology. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):49.
Turkmani MG, De Boulle K, Philipp-Dormston WG. Delayed hypersensitivity reaction to hyaluronic acid dermal filler following influenza-like illness. Clin Cosmet Investig Dermatol. 2019;12:277-283.
Ackerman M, Henry D, Finon A, et al. Persistent maculopapular rash after the first dose of Pfizer-BioNTech COVID-19 vaccine. J Eur Acad Dermatol Venereol. 2021;35(7):e423-e425.
Corbeddu M, Diociaiuti A, Vinci MR, et al. Transient cutaneous manifestations after administration of Pfizer-BioNTech COVID-19 Vaccine: an Italian single-centre case series. J Eur Acad Dermatol Venereol. 2021;35(8):e483-e485.
Gunes AT, Fetil E, Akarsu S, et al. Possible triggering effect of influenza vaccination on psoriasis. J Immunol Res. 2015;2015:258430.
Yoneyama S, Kamiya K, Kishimoto M, et al. Generalized exacerbation of psoriasis vulgaris induced by pneumococcal polysaccharide vaccine. J Dermatol. 2019;46(11):e442-e443.
Atzori L, Pinna AL, Ferreli C, Aste N. Pityriasis rosea-like adverse reaction: review of the literature and experience of an Italian drug-surveillance center. Dermatol Online J. 2006;12(1):1.
Drago F, Ciccarese G, Javor S, Parodi A. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. J Eur Acad Dermatol Venereol. 2016;30(3):544-545.
Buckley JE, Landis LN, Rapini RP. Pityriasis rosea-like rash after messenger RNA COVID-19 vaccination: A case report and review of the literature. JAAD Int. 2022;7:164-168.
Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489-e491.
Ramot Y, Nanova K, Faitatziadou SM, et al. Six cases of pityriasis rosea following SARS-CoV-2 vaccination with BNT162b2. J Dtsch Dermatol Ges. 2022;20(8):1123-1124.
Broccolo F, Drago F, Careddu AM, et al. Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. J Invest Dermatol. 2005;124(6):1234-1240.
Carballido Vázquez AM, Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination. Br J Dermatol. 2021;185(2):e34.
Kohn D, Wetzig T. [Zostererkrankung nach Shingrix-Impfung]. Hautarzt. 2021;72(8):729-732.
Walter R, Hartmann K, Fleisch F, et al. Reactivation of herpesvirus infections after vaccinations? Lancet. 1999;353(9155):810.
Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine - United States, December 14-23, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(2):46-51.
Wöhrl S. Allergie und COVID-19 - Daten statt Polemik. J Dtsch Dermatol Ges. 2021;19(5):794-795.
Park HJ, Montgomery JR, Boggs NA. Anaphylaxis after the Covid-19 Vaccine in a patient with cholinergic urticaria. Mil Med. 2022;187(9):e1556-e1558.