key: cord-0695050-zj6tb25o
authors: Adeliño, Raquel; Andrés-Cordón, Joan F.; de la Cruz Martínez, Cinthia Araceli
title: Acute urticaria with angioedema in the setting of coronavirus disease 2019
date: 2020-05-05
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.04.061
sha: 3fc7db80bbbd7a863c5b05970ffdeb52344c71af
doc_id: 695050
cord_uid: zj6tb25o

nan

for pine seeds allergy, following a strict nut-free diet since she was diagnosed. Lipid transfer 34 protein syndrome was ruled out at diagnosis. She did not have a family history of hereditary 35 angioedema, and she was not on any medication. In March 2020, she presented with 36 symptoms of odynophagia and dry cough, with rapid onset of fever. The day after the 37 symptoms appeared, a polymerase chain reaction (PCR) of upper-airway secretions (by 38 nasopharyngeal swab) was performed, revealing Severe acute respiratory syndrome 39 coronavirus-2 (SARS-CoV-2) infection. With this positive result, she was instructed to remain in 40 strict home isolation. She evolved satisfactorily, with 4 days of fever and dry cough, followed 41 by 5 days of total anosmia and ageusia from which she completely recovered. On day +11 of 42 disease evolution, after resolution of the previous symptoms, rapidly spreading wheals 43 developed in various locations on her body: face, trunk, abdomen and limbs. In few hours, face 44 wheals promptly converted to facial angioedema (figure 1), with preferential involvement of 45 periocular region and mild edema of the lips, without compromise of the tongue, uvula, vocal 46 cords, or the airway. No other symptoms were noted. The appearance of the lesions was not 47 related to food intake (she had not eaten nuts). She had not taken non-steroidal inflammatory 48 drugs (NSAIDs) or angiotensin converting enzyme (ACE) inhibitors the previous fifteen days. 49

She had not exercised, had not drunk alcohol, or was on menstrual period. As symptomatic 50 treatment, only an antihistamine was taken (ebastine 10mg ter in die). 24 hours after the 51 onset of the cutaneous symptoms, both the wheals and angioedema started to fade off, 52 turning into erythematous macules until complete resolution. From there on, she remained 53 asymptomatic. On day +15, upper-airway secretion PCR was performed again, persisting still 54 positive for SARS-CoV-2 and therefore proving the presence of this virus in the respiratory 55 tract. After 7 more days of home isolation, repeated PCR on day +22 was finally negative. worldwide, with more than 2.7 million cases from December 2019 to date (2) . 60

The symptoms and syndromes caused by this disease are diverse. The most frequent 61 symptoms are fever, cough, dyspnea, as well as fatigue and malaise (3) . Diarrhea, anosmia and 62 ageusia have also been described. Furthermore, this disease can also cause severe syndromes 63 as pneumonia, respiratory distress syndrome (RDS), multiple organ failure secondary to sepsis 64 and death (3) . 

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