Delayed-Onset Urticaria Following Vaccination for COVID-19

Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose(s): The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Method(s): A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Result(s): We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion(s): Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases. Copyright © 2022 Journal of Dermatology and Dermatologic Surgery.

Systematic Reviews of Different Types of Drug Delivery in the Treatment and Prevention of Oral and Dental and Cardiorespiratory Diseases in Patients and Animals Involved in the Disease

This study has systematically investigated the types of drug delivery in the treatment and prevention of oral and dental and cardiorespiratory diseases in patients and animals involved in the disease. Early recognition of risk factors and primary prevention significantly reduces complications and mortality in chronic heart diseases. Lifestyle modification with diet, exercise and smoking cessation is very important to reduce cardiovascular risk factors. In the first days of the disease, when the patient has mild symptoms and has not yet developed respiratory symptoms, you can start treatment with painkillers for headache, sore throat and body pain, along with taking antitussive medicine and vitamin D and C although scientifically the effect of vitamin C. It is not proven, but considering that we still do not have extensive studies on this disease, it seems that taking vitamins may help the patient. Sometimes, some patients themselves start treatment with azithromycin, while this antibiotic has an effect on antibacterial infections and has no effect on the disease of Covid-19. Favipiravir treatment should be started in high-risk outpatients with corona. Of course, along with treatment with favipiravir and similar antiviral effects, it can be effective in the treatment of corona. Famotidine and melatonin, which help improve sleep and are said to have antiviral effects. Of course, melatonin medicine should be taken at around 11 to 12 at night. Because it affects the sleep and wake cycle. Montelukast along with fexofenadine, can have antiviral effects for covid-19 patients. Since the beginning of the Corona pandemic, the world has emphasized on the monthly consumption of vitamin D, but if you do not have a monthly intake, use 1000 milligrams daily or up to 50 thousand units every week and after some time continue to consume vitamin D on a monthly basis. It is also recommended to take vitamin C and magnesium, and it is better for patients to eat foods rich in protein, potassium, and dairy products.

First documented case of urticarial vasculitis following the AstraZeneca COVID-19 vaccine

The COVID-19 pandemic resulted in a rapid requirement for a safe and effective vaccination programme. Currently, three types of vaccines exist: mRNA (Pfizer), adenoviral vector (AstraZeneca) and inactivated whole-virus vaccines (Sinofarm). These all have reported cutaneous side-effects, including papulovesicular, pityriasis rosea-like and papulosquamous eruptions (McMahon DE, Kovarik CL, Damsky W et al. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: a registry-based study. J Am Acad Dermatol 2021;86: 113-21). We present a case of delayed type III hypersensitivity reaction clinically resembling urticarial vasculitis (UV) in a 66-year-old woman following AstraZeneca vaccine. She initially reported urticarial lesions on the hands after the first vaccination;these settled spontaneously. On subsequent vaccination she developed a florid rash 4 days later, presenting to Accident & Emergency with angio-oedema, malaise and urticaria. The eruption was presumed viral given the mildly elevated C-reactive protein, and negative lateral flow test for COVID-19. She was given fexofenadine 180 mg QDS for 6 weeks;however, the rash persisted and became more widespread over the following 4 weeks. The initial urticated wheals persisted >24 h, becoming bruise-like and painful. Skin biopsy confirmed UV. ANA, complement, ANCA and COVID-19 polymerase chain reaction were nonsignificant. We believe this is the first documented case of UV triggered by the AstraZeneca vaccine and the third case of UV following a Sars-CoV-2 vaccine reported in English literature. The two other cases were secondary to Pfizer and whole-virus vaccine, respectively. From the literature it is believed UV is potentially caused by the coronavirus particles rather than vaccine additives, as the Sars-CoV-2 nucleocapsid has been demonstrated in skin lesions of asymptomatic COVID-19 patients with UV (Criado PR, Criado RFJ, Gianotti R et al. Urticarial vasculitis revealing immunolabelled nucleocapsid protein of SARS-CoV-2 in two Brazilian asymptomatic patients: the tip of the COVID-19 hidden iceberg? J Eur Acad Dermatol Venereol 2021;35: e563-6). Thus, although rare, clinicians should be aware of this entity.

Leukemoid reaction in a patient with COVID-19 infection: A case report

Rationale: COVID-19 usually presents with flu-like symptoms and signs, but some rare presentations like leukemoid symptoms cannot be ignored. Patient's concerns: A 37-year-old female presented to the outpatient department with flu-like symptoms. Diagnosis: The RT-PCR test for SARS-CoV-2 infection was positive, while complete blood cell and peripheral blood smear showed leukemoid reaction. Intervention: Paracetamol and fexofenadine for flu-like symptoms and leukemoid presentation. Outcomes: On the 10th day, the patient was asymptomatic and RT-PCR was negative. So the patient was discharged and leukemoid presentation subsided after clearance of viral disease. Lessons: COVID-19 has a myriad of presentations, and unusual symptoms/signs especially in this pandemic could be induced by COVID-19 infection.

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

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.