Nonepisodic angioedema with eosinophilia after COVID-19 vaccination: a case successfully treated with reslizumab

Abstract

Background Angioedema with eosinophilia (AE) is a rare allergic disease classified as episodic or nonepisodic. AE is characterized by angioedema, urticaria, fever, weight gain, and eosinophilia, but its etiology and pathogenesis have not yet been clarified. Case presentations We present a 70-year-old woman presented with generalized edema and urticaria after Moderna COVID-19 vaccination. Peripheral blood eosinophil count was marked elevated and echocardiography and Doppler ultrasonography of both the upper and lower extremities were unremarkable. Her symptoms and peripheral blood eosinophil count were improved after systemic steroid therapy, but she failed to respond to steroid tapering. Reslizumab (anti-interluekin-5) was administered intravenously, and she remained symptom free with a normal eosinophil count during 8 months of reslizumab treatment without steroids. Conclusions We report a case of nonepisodic AE after COVID-19 vaccination that was successfully treated with reslizumab.

Nonepisodic angioedema with eosinophilia following a rose-thorn prick injury

“…This case represents the first reported instance of NEAE caused by a rose-thorn prick. Although most cases of NEAE have an unknown etiology, we found nine cases with identified caused in the literature [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ] ( Table 1 ). In the literature, all reported patients were women between ages of 26 and 89 years with an incubation period of less than 2 weeks for most cases.…”

“…Most cases were associated with eosinophilia and elevated TARC levels and responded to steroid treatment without recurrence. Five of the nine cases were triggered by vaccination [ 5 , 6 , [9] , [10] , [11] ], while the remaining cases involved mycoplasma infection with skin lesions [ 4 ], SARS-CoV-2 infection [ 7 ], sublingual immunotherapy for house dust mite [ 8 ], and rose-thorn prick (our case). Both the vaccination cases and our case were triggered by direct subcutaneous antigen exposure, leading to NEAE.…”

“…NEAE has traditionally been considered a disease predominantly affecting young women, with a previous review of 37 cases reporting an age range of 20–37 years (mean age: 26 years) [ 2 ], with sex hormones thought to play a role in its onset [ 7 , 8 ]. Reports of NEAE in elderly are extremely rare [ 14 ]; however, our review found that four of the nine cases involved postmenopausal women and were associated with vaccination [ 5 , 6 , 9 , 10 ]. This suggests that NEAE triggered by vaccines may not be related to sex hormones.…”

Nonepisodic Angioedema with Eosinophilia Following Receipt of the BNT162b2 mRNA COVID-19 Vaccine

“…The other patient was a 76-year-old woman with a history of drug rash caused by cephalosporin who was treated for NEAE with antihistamines, and the symptoms resolved in 6 weeks ( 29 ). Recently, a 70-year-old woman with diabetes developed NEAE after mRNA-1273 injection ( 30 ). She was treated with systemic steroids from day 20 of the onset and reslizumab from day 124, with her condition controlled by 138 days ( Table ).…”