Relapse or worsening of chronic spontaneous urticaria during SARS-CoV-2 infection and vaccination in children: A telemedicine follow-up

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 tele-medicine 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.

New-onset chronic spontaneous urticaria development after COVID-19 vaccination

“…Seventh, Craffert et al 1 emphasized that “there was no available literature describing new-onset CSU post–COVID-19 infection”; however, when we searched PubMed, we found a couple of studies showing that SARS-CoV-2 infection can also cause new-onset CSU. 5 We also agree with the opinion expressed by Craffert et al 1 that new-onset CSU can occur after SARS-CoV-2 infection.…”

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

“…Duperrex et al [ 122 , 125 ] analyzed 862 cases of post-SARS-CoV-2 vaccine CSU cases which occurred mainly after the 3rd dose (booster) of mRNA vaccines. The overall crude incidence rate of CSU after a SARS-CoV-2 booster per 100,000 persons immunized with a booster was 24 and 19 in the two cohorts, respectively.…”

“…The authors also observed that fewer exacerbations happened when patients were under omalizumab therapy [ 124 , 127 ]. Likewise, Lascialfari et al [ 125 , 128 ] reported that relapse or exacerbation of urticaria after SARS-CoV-2 vaccination was observed in only 7.7% of pediatric CSU patients which lasted for less than one week. Picone et al [ 126 , 129 ] reported postvaccine urticaria to flare up in 8% of CSU patients who were well controlled under antihistamine and omalizumab treatment, while Tuchinda et al [ 127 , 130 ] reported a higher rate (15%).…”

The effect of COVID-19 and COVID-19 vaccines on chronic spontaneous urticaria: single center experience

“…4/26 (19.2%) cases who had COVID-19 manifested with CSU recurrence, while 1 (3.8%) had a CSU worsening/deterioration. Meanwhile, 1/26 (3.8%) vaccinated patient had a recurrence of CSU, and 1 (3.8%) had a deterioration of CSU course [7].…”