Cutaneous and Allergic reactions due to COVID‐19 vaccinations: A review

Abstract

Introduction The pandemic caused by the novel coronavirus disease 2019 (COVID‐19) has had an unprecedented impact on the overall health and the global economy. Vaccination is currently the most dependable strategy to end the pandemic, despite the slower‐than‐hoped‐for rollout, particularly for low‐to‐middle‐income countries, and the uncertain duration of protection afforded by vaccination. The spike protein of the virus (immunodominant antigen of the virus) is the main target of the approved and candidate SARS‐CoV‐2 vaccines. This protein binds to the ACE2 receptor of the host cell, initiating the entry of the virus into the cell and the chain of subsequent events ending to Acute Respiratory Distress Syndrome. The safety profile of these vaccines needs is closely assessed. Methods This comprehensive review includes searching the PubMed, EMBASE, and Web of Science databases using the keywords “coronavirus”, “COVID‐19”, “vaccine”, “cutaneous reactions”, “allergic reactions”, and “SARS‐CoV‐2”. Manual searching of reference lists of included articles augmented the research. The research was updated in June 2021. Results In this narrative review, we tried to investigate and discuss the cutaneous and allergic reactions related to SARS‐CoV‐2 vaccines currently available in the literature. As a result, although COVID‐19 vaccines can be reported to develop allergic and anaphylactic reactions, especially after m‐RNA vaccines, they remain at a low rate, and it is observed that these reactions may develop more frequently, especially in patients with previous allergies and mast cell disorders. Fortunately, these reactions are generally transient, benign, self‐limited. Conclusion Although there is still no definitive evidence, as dermatologists, we must be aware of the possibility of cutaneous reactions, newly diagnosed dermatoses, or exacerbation of existing dermatoses that may develop after the COVID‐19 vaccinations.

An extremely rare mucocutaneous adverse reaction following COVID ‐19 vaccination: Toxic epidermal necrolysis

“…The cutaneous adverse reactions include cases of injection site reactions, exanthemas, eczematous dermatitis, urticarial, vascular lesions, autoimmune bullous diseases and also severe cutaneous adverse reactions (such as SJS/TEN), the latter of which has been reported rarely. The most of the cutaneous reactions are mild, limited to skin and with rapid resolution 9,10 . Anaphylaxis and severe cutaneous adverse reactions including SJS/TEN, are life‐threatening and represent contraindications for a second vaccine dose 11,12 …”

Role of Allergist Advice in Determining Personal Decisions for COVID-19 Vaccination of People With a History of Allergies

“…There is a clear need for further studies in atopic populations to elucidate mechanisms and assess the risk of allergic reactions and anaphylaxis in these individuals, as well as to assist them with guidelines recommendations regarding vaccine allergy risk [17][18]. The role of allergists appears to be important, considering this task, and is influenced by the number of specialists and the situation of the specialty in each country.…”

Woman with pruritic rash and dermatographism

“… 1 , 2 , 3 Cutaneous manifestations are variable in appearance and time to presentation and may include urticarial, morbilliform, and vasculitic eruptions, as well as delayed localized injection site reactions and chronic spontaneous urticaria. 4 , 5 , 6 , 7 Chronic spontaneous urticaria is characterized by urticaria occurring on most days of the week over 6 weeks or longer. 8 Therapy includes second‐generation antihistamines and avoidance of known triggers (eg, medications, stress).…”

“…Up to 10.5% of patients experience cutaneous adverse reactions following COVID‐19 vaccination 1–3 . Cutaneous manifestations are variable in appearance and time to presentation and may include urticarial, morbilliform, and vasculitic eruptions, as well as delayed localized injection site reactions and chronic spontaneous urticaria 4–7 . Chronic spontaneous urticaria is characterized by urticaria occurring on most days of the week over 6 weeks or longer 8 .…”

“…[1][2][3] Cutaneous manifestations are variable in appearance and time to presentation and may include urticarial, morbilliform, and vasculitic eruptions, as well as delayed localized injection site reactions and chronic spontaneous urticaria. [4][5][6][7] This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2022 The Authors.…”