SARS‐CoV‐2 infection as a potential triggering factor for urticarial vasculitis during pregnancy: A case report

Dadras, Mohammad Shahidi; Rakhshan, Azadeh; Diab, Reem; Abdollahimajd, Fahimeh

doi:10.1002/ccr3.4323

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…new use or changes in medication) [ 40 ], urticaria could be directly related to the pathogenesis of COVID-19. The effect of COVID-19 on the vascular system can occur either directly through cell invasion, or indirectly through inflammation, along with increased levels of leukocytes, cytokines, and chemokines which result in endothelial damage [ 31 ]. It is hypothesized that mast cell degranulation is the principal pathophysiological mechanism associated with the systemic organ damage observed in patients with severe forms of COVID-19 [ 29 ].…”

Section: Pathophysiology Of Urticariamentioning

confidence: 99%

Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Ansotegui

Bernstein

Canonica

et al. 2022

Allergy Asthma Clin Immunol

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Objective The present narrative review provides a comprehensive update of the current knowledge on urticaria, both in adult and pediatric populations, and on the safety and efficacy of fexofenadine hydrochloride (HCl) as a treatment option. Data source A literature search was conducted on Embase and Medline. Study selection Clinical studies published in English and published between 1999 and 2020 were selected. Results Although the exact pathogenesis of urticaria is not fully understood, multiple pathways of mast cell activation are discussed to explain the existence of phenotypically different clinical manifestations of urticaria. An overview of the worldwide prevalence of chronic urticaria, including disease burden and patient’s quality of life is provided. The impact of urticaria on patient’s life differs on the basis of whether its form is acute or chronic, but pharmacological approaches are most often needed to control the disabling symptoms. A summary of the current management of urticaria recommended by different guidelines across countries (Global; European; American; Australian; Asian; Japanese) is presented. Non-sedating, second-generation H1-antihistamines are the preferred choice of treatment across several guidelines worldwide. Herein, the efficacy and safety of fexofenadine HCl, a representative second-generation H1-antihistamine approved for the treatment of urticaria, is discussed. The occurrence of urticaria manifestations in COVID-19 patients is also briefly presented. Conclusion The burden of acute and chronic urticaria is high for patients. Second generation anti-histamines such as fexofenadine HCl can help managing the symptoms.

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Section: Pathophysiology Of Urticariamentioning

confidence: 99%

Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Ansotegui

Bernstein

Canonica

et al. 2022

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

show abstract

“…Although the cause of UV often remains unclear, trigger factors such as drugs, infections, autoimmune diseases, and malignancy have been described ( 30 , 31 ). Though rare, UV has been described in either symptomatic or asymptomatic COVID-19 patients ( 32 – 34 ). Interestingly, its onset has also been reported a few weeks following recovery from COVID-19 ( 35 ).…”

Section: Covid-19-associated Cutaneous Vasculitis/vasculopathymentioning

confidence: 99%

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

et al. 2022

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Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.

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COVID-19 Vasculitis and vasculopathy-Distinct immunopathology emerging from the close juxtaposition of Type II Pneumocytes and Pulmonary Endothelial Cells

et al. 2022

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The SARS-CoV-2 virus ACE-2 receptor utilization for cellular entry and the defined ACE-2 receptor role in cardiovascular medicine hinted at dysregulated endothelial function or even direct viral endotheliitis as the key driver of severe COVID-19 vascular immunopathology including reports of vasculitis. In this article, we critically review COVID-19 immunopathology from the vasculitis perspective and highlight the non-infectious nature of vascular endothelial involvement in severe COVID-19. Whilst COVID-19 lung disease pathological changes included juxta-capillary and vascular macrophage and lymphocytic infiltration typical of vasculitis, we review the evidence reflecting that such “vasculitis” reflects an extension of pneumonic inflammatory pathology to encompass these thin-walled vessels. Definitive, extrapulmonary clinically discernible vasculitis including cutaneous and cardiac vasculitis also emerged- namely a dysregulated interferon expression or “COVID toes” and an ill-defined systemic Kawasaki-like disease. These two latter genuine vasculitis pathologies were not associated with severe COVID-19 pneumonia. This was distinct from cutaneous vasculitis in severe COVID-19 that demonstrated pauci-immune infiltrates and prominent immunothrombosis that appears to represent a novel immunothrombotic vasculitis mimic contributed to by RNAaemia or potentially diffuse pulmonary venous tree thrombosis with systemic embolization with small arteriolar territory occlusion, although the latter remains unproven. Herein, we also performed a systematic literature review of COVID-19 vasculitis and reports of post-SARS-CoV-2 vaccination related vasculitis with respect to the commonly classified pre-COVID vasculitis groupings. Across the vasculitis spectrum, we noted that Goodpasture’s syndrome was rarely linked to natural SARS-CoV-2 infection but not vaccines. Both the genuine vasculitis in the COVID-19 era and the proposed vasculitis mimic should advance the understanding of both pulmonary and systemic vascular immunopathology.

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SARS‐CoV‐2 infection as a potential triggering factor for urticarial vasculitis during pregnancy: A case report

Cited by 4 publications

References 13 publications

Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

COVID-19 Vasculitis and vasculopathy-Distinct immunopathology emerging from the close juxtaposition of Type II Pneumocytes and Pulmonary Endothelial Cells

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