key: cord-0746035-9ep49tho
authors: Zipursky, Jonathan S.; Croitoru, David
title: Urticaria and angioedema associated with SARS-CoV-2 infection
date: 2021-09-07
journal: CMAJ
DOI: 10.1503/cmaj.211087
sha: 60524eb023f3fc9df824e1746166d0c688a2dd03
doc_id: 746035
cord_uid: 9ep49tho

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precedes or occurs concurrently with typical COVID-19 symptoms, but can rarely occur after other symptoms have resolved. 2 Urticaria, perniolike lesions and morbilliform exanthems are the most common cutaneous manifestations of COVID-19. 3 The pathophysiology may be related to complement and mast cell activation by the direct cytopathic effects of SARS-CoV-2, as well as cytokine signalling. Furthermore, SARS-CoV-2 downregulation of angiotensin-converting enzyme 2, leading to increased levels of angiotensin II, may exacerbate vasoconstriction or vascular permeability. 4 In patients who present with new-onset urticaria or angioedema, clinicians should ask about infectious disease symptoms, including those related to COVID-19. We do not suggest routine SARS-CoV-2 testing in patients who are otherwise asymptomatic. Symptomatic urticaria related to SARS-CoV-2 infection should be treated with second-and third-generation nonsedating antihistamines, up to 4 times the usual dose, if needed. 5 Low-dose systemic corticosteroids can be considered in severe cases. 5 

Skin manifestations associated with COVID-19: current knowledge and future perspectives

Urticaria and COVID-19: a review

The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries

Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19

Management of urticaria in COVID-19 patients: a systematic review