Characteristics of immune response profile in patients with immediate allergic and autoimmune urticarial reactions induced by SARS-CoV-2 vaccines

How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19

“…Those reports included mostly women, ages ranging between 20 to 78 with symptoms occurring from 4 days to 3 months after vaccination. In some of these, a case of symptomatic dermographism was reported and some but not all cases had accompanying angioedema [ 119 , 120 , 122 , 123 ].…”

“…A recent study from Korea analyzed patients who developed allergic reactions after SARS-CoV-2 vaccination [ 123 , 126 ]. A total of 129 patients [42 had an immediate allergic reaction (≤24 h) while 87 developed delayed urticaria (>24 h)] were compared to a control group who did not develop any cutaneous reaction after 8 weeks of at least two doses of SARS-CoV-2 vaccination ( n = 115).…”

“…They also showed that these CU patients triggered by SARS-CoV-2 vaccines respond favorably to treatment with omalizumab. In their cohort of 129 patients who had experienced SARS-CoV-2 vaccines-induced immediate allergy and CU, approximately 6.3–20% of patients further relapsed itchy and skin rash after following re-vaccination and they suggested that performing ex vivo tests to identify the main culprit component or excipient of vaccines may help to decrease the incidence of cutaneous reactions induced by SARS-CoV-2 vaccines [ 123 , 126 ].…”

“…Given that in the majority of cases the urticarial reactions described in the literature did not recur with subsequent vaccinations, the skin tests performed with vaccine ingredients were negative [ 105 , 109 , 113 ]; however, there are also opposing findings which were reported in a recent study by Wang et al where they found positivity by ex vivo tests with PEG and tromethamine. Furthermore, this was the case for spike protein for the first time, though they did not find a difference between allergic and control patients in terms of anti-PEG IgE and anti-spike IgE antibodies [ 123 , 126 ].…”

“…Wang et al also suggested that the vaccine components activate T cells and result in delayed hypersensitivity or urticarial reactions since they found that many cytokines and chemokines such as IL-2, IL-4, IL-6, IL-17 A TARC/CCL17, PARC/CCL18, and MIG/CXCL9 were elevated in patients who reacted to SARS-CoV-2 vaccines [ 123 , 126 ].…”