Urticaria 12 Days After COVID-19 mRNA Booster Vaccination

Abstract

A healthy 27-year-old woman received a COVID-19 mRNA booster vaccine (Moderna) on December 7, 2021. She had not experienced adverse effects after the first 2 vaccine doses on January 17 and February 5, 2021. Twelve days after the booster vaccination, she developed pruritic wheals on her face and bilateral, transient eyelid swelling. Over the next week, a pruritic rash spread over her neck, chest, trunk, and arms; each lesion faded without scarring within 24 hours. She did not experience lip, tongue, or neck swelling; shortness of breath; wheezing; chest pain; or palpitations. Application of pressure to her forearm in a circular motion using a pen cap elicited wheal and flare lesions (Figure, left panel). On physical examination, performed 17 days after the onset of rash, her vital signs were normal. She had no tongue, lip, or throat swelling, and her lungs were clear to auscultation bilaterally. Wheal and flare lesions developed on her upper eyelids during the examination and resolved after approximately 30 minutes (Figure, right panel). Light pressure applied to her skin with a tongue depressor elicited wheal and flare lesions within 3 to 5 minutes.The patient had no history of atopy, urticaria, angioedema, or food or drug allergy and no recent infections. She took no prescription medications and reported no recent use of over-the-counter medications, including nonsteroidal anti-inflammatory drugs. She had no recent travel, exposure to animals, or use of new personal care products.

Clinical and immunological data from chronic urticaria onset after mRNA SARS‐CoV‐2 vaccines

“…for 4 weeks with persistent dermographism 12 days after the third dose (booster) with mRNA-1273. 6 In a recent retrospective study, 32…”

“… 5 An otherwise healthy woman presented with urticaria for 4 weeks with persistent dermographism 12 days after the third dose (booster) with mRNA‐1273. 6 In a recent retrospective study, 32 patients with new‐onset persistent urticaria and CSU in remission that relapsed within 3 months from BNT 162b2 mRNA vaccination were analysed. 7 A positive autologous serum skin test and low basophil count in the peripheral blood were positively associated with the likelihood of CSU recurrence after vaccination with BNT162b2 mRNA.…”

Features of chronic urticaria after COVID-19 mRNA vaccine, a real-life cohort study

“…Yet, these COVID-19 vaccines were associated with several adverse effects with up to 17'000 reports of suspected adverse drug reactions collected in Switzerland by February 2023 (7,8). In particular, new onsets of chronic urticaria (CU) have been reported after repeated immunizations, mainly with the Spikevax vaccine (9)(10)(11).…”

Rapid onset of chronic urticaria after Moderna COVID-19 booster vaccine

“…The booster was approved end of November 2021 by the Swiss regulatory agency (Swissmedic) for the ≥18-year-old population. Since then, we have observed a substantial number of chronic spontaneous urticaria (CSU) rapidly after the booster dose [2, 3]. CSU is defined as recurrent wheals, angioedema, or both for a duration of >6 weeks, frequently associated with a substantial impact on the health-related quality of life [4].…”