key: cord-0729128-iqf05b1b authors: Savva, Demetris; Battineni, Gopi; Amenta, Francesco; Nittari, Giulio title: Hypersensitivity reaction to hyaluronic acid dermal filler after the Pfizer vaccination against SARS-CoV-2 virus date: 2021-09-29 journal: Int J Infect Dis DOI: 10.1016/j.ijid.2021.09.066 sha: d0843d3f25c187f0683455585058200b3fc2507a doc_id: 729128 cord_uid: iqf05b1b The ongoing vaccination program in control of the novel coronavirus is providing opportunity to public health emergency authorises for coming out of this current pandemic crisis. At the same time, the side effects including normal signs like pains, redness, swelling and others are affecting the daily life activities. In this report, we confirmed case of 38-year-old female patient with hypersensitivity reaction after having the BNT162b2 (Pfizer-USA) vaccine. This case reporting the importance of patient knowledge prior hyaluronic acid injections of the possible adverse effect of a delayed-type hypersensitivity reaction during COVID-19 vaccination. After the origination of novel coronavirus (2019-nCoV) also known as SARS-CoV-2 (Severe acute respiratory syndrome Coronavirus-2) infected more than 173 million including of 3.7 million deaths (Home -Johns Hopkins Coronavirus Resource Center, n.d.) . In the last sixteen months world facing plenty of crisis because of this severe pandemic (Galanakis, 2020) . Governments all over the world has been rush to implement serious measures on human activities to control the virus spreading. Distribution of vaccination is now offering a way to coming out this dreadful phase. Fortunately, since the beginning of 2021 numerous vaccines are come in hand and had emergency approval to launch over all parts of globe (Shrotri et al., 2021) . Stats reporting that till end of May 2021, 2.02 billion doses provided word wide and 443 million people are fully vaccinated. However, the healthcare challenges caused by COVID-19 global vaccination still remain same to be addressed and also impact its success rate (Polack et al., 2020) . In this case report, we tried to highlight the hypersensitivity reaction to hyaluronic acid dermal filler after the having the BNT162b2 vaccine (Pfizer-USA) vaccination against SARS-CoV-2 virus. It is reported that five cases of delayed-type hypersensitivity reaction to dermal fillers, with influenza-like symptoms a couple of days before the onset of inflammation (Bhojani-Lynch, 2017) . Oral corticosteroids were used to deal with the inflammation and hyaluronidase to suppress the persistent areas. Similarly, another on 14 cases of delayed-type hypersensitivity reactions to fillers following an influenza-like illness (Turkmani et al., 2019a) . Almost all cases were dealt with oral corticosteroids again, whereas a few persistent nodules needed intralesional hyaluronidase injections to be dissolved completely. There is no evidence of delayed hypersensitivity afterwards of hyaluronic acid fillers following influenza vaccination. Clinical trials of the major vaccines (Pfizer-BioNTech, Moderna, and AstraZeneca) have reported some cutaneous adverse reactions (Baden et al., 2021; Jackson et al., 2020; Mulligan et al., 2020; Ramasamy et al., 2020; Walsh et al., 2020) . Rosacea and pruritus occurred in the AstraZeneca vaccine trials whereas transient urticaria and a case of angioedema was noted in the Moderna vaccine trial. It is important to note that no cases of delayed type hypersensitivity reactions are noted for AstraZeneca and Pfizer vaccines. We can conclude that either they didn't take place or the number of cases didn't meet the minimum threshold incident value for the protocol for reporting the adverse effects. It has been noted in the literature various cases of delayed-type hypersensitivity reactions in respect to viral vaccines and illnesses. The exact mechanism of triggering a delayed-type hypersensitivity reaction in our case is yet to be clarified, but we confirm that it is an immunologic reaction between the hyaluronic acid filler and the SARS-CoV-2 vaccine. Generally, hyaluronic acid fillers are very safe to use, but sometimes minimal side effects can occur. Therefore, the aesthetic practitioner must be aware of those side effects, any precautions prior and after use, and also the contraindications of using hyaluronic acid fillers. It is of uttermost importance patient informed consent in aesthetic practices, especially about the possible side effects after influenza-like illness and nowadays after Covid-19 infection and/ or after Covid 19 vaccination. The American Society of Dermatologic Surgery (ASDS) is providing a guidance report on SARS-CoV-2 vaccine related adverse effects, and more specifically on delayed dermal filler inflammatory reactions. Therefore, informing the patient about these rare but possible adverse reactions before proceeding with the treatment is necessary. In addition, another important point is to inform patients that have already underwent hyaluronic acid filler injections prior to their vaccination, the rare possibility of a delayed-type hypersensitivity reaction, as part of the post-vaccination adverse effects. Ethical approval: Written informed consent for publication of her clinical details and images were obtained from the patient. Authors declaring that no financial or other competing interests are reporting in this work. Funding: This work is not receiving any source of funding. 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