key: cord-0951514-vojbs6tu
authors: Myrdal, Caitlyn N.; Culpepper, Keliegh S.; Leyo DuPont, Sandra
title: Generalized dermal hypersensitivity reaction following Moderna COVID‐19 vaccination
date: 2021-11-06
journal: Dermatol Ther
DOI: 10.1111/dth.15173
sha: f174d1df376b5e62794d43b34311c11307453b69
doc_id: 951514
cord_uid: vojbs6tu

nan

Dear Editor, Delayed immunologic reactions have been described in association with the novel mRNA COVID-19 vaccines. We report the case of a 40-yearold male who presented with widespread pruritic urticarial indurated papules and plaques on the arms, legs, palms, and face 9 days following his first Moderna vaccination ( Figure 1A injection-site reactions were observed in 103 subjects (2.1%). 2 Microscopic analysis of these sites revealed an inflammatory infiltrate consistent with a hypersensitivity reaction. 2 Widespread reactions may cause concern for both patients and healthcare professionals. The difference between type I IgE-mediated hypersensitivity reactions, which are associated with anaphylaxis and occur within hours of inoculation, and type IV delayed hypersensitivity reactions, which are driven by a T-cell mediated inflammatory response, should be emphasized. In our case, the presumed type IV delayed hypersensitivity eruption was not associated with additional symptoms and did not recur after the second vaccination. These findings are consistent with those of McMahon et al., who emphasize that in cases of delayed urticarial reactions, there were no reports of anaphylaxis and only four individuals experienced urticarial eruption after both doses. 5 Given these points, we suggest that delayed generalized hypersensitivity following initial inoculation should not be a contraindication to subsequent COVID-19 vaccination.

In summary, delayed generalized hypersensitivity reactions may be observed in association with the novel mRNA COVID-19 vaccines.

However, reports remain limited and further characterization of incidence, clinical course, and effective treatment will be crucial in understanding this entity.

COVID arm": a reaction to the Moderna vaccine

Skin manifestations of the BNT162b2 mRNA COVID-19 vaccine in healthcare workers

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COVID arm": very delayed large injection site reactions to mRNA COVID-19 vaccines

Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registrybased study of 414 cases

Delayed localized hypersensitivity reactions to the Moderna COVID-19 vaccine: a case series

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

Delayed hypersensitivity reactions caused by drug excipients: a literature review