Urticaria exacerbations and adverse reactions in patients with chronic urticaria receiving COVID-19 vaccination: Results of the UCARE COVAC-CU study

Emek Kocatürk*, Pascale Salameh, Esra Sarac, Carolina E. Vera Ayala, Simon Francis Thomsen, Torsten Zuberbier, Luis Felipe Ensina, Todor A. Popov, Martijn B.A. van Doorn, Ana Maria Giménez-Arnau, Riccardo Asero, Paulo Ricardo Criado, Fernando M. Aarestrup, Zainab AbdulHameed Ansari, Salma Al Abri, Mona Al Ahmad, Bushra Al Hinai, Anastasiia Allenova, Maryam Al-Nesf, Sabine AltrichterRand Arnaout, Joanna Bartosińska, Andrea Bauer, Jonathan A. Bernstein, Mojca Bizjak, Hanna Bonnekoh, Laurence Bouillet, Zenon Brzoza, Ana Caroline Calvalcanti Dela Bianca Melo, Fernanda L. Campinhos, Emily Carne, Saleema Cherichi Purayil, Ivan Cherrez-Ojeda, Herberto Jose Chong-Neto, George Christoff, Niall Conlon, Roberta Fachini Jardim Criado, Klara Cvenkel, Ebru Damadoglu, Inna Danilycheva, Cascia Day, Laurence de Montjoye, Semra Demir, Silvia Mariel Ferucci, Daria Fomina, Atsushi Fukunaga, Elizabeth Garcia, Asli Gelincik, Joe Hannah Göbel, Kiran Godse, Margarida Gonçalo, Maia Gotua, Clive Grattan, Agata Gugala, Carole Guillet, Ali Fuat Kalyoncu, Gul Karakaya, Alicja Kasperska-Zając, Constance H. Katelaris, Maryam Khoshkhui, Andreas Kleinheinz, Marta Kolacinska-Flont, Pavel Kolkhir, Mitja Košnik, Dorota Krasowska, Muthu Sendhil Kumaran, Izabela Kuprys-Lipinska, Marcin Kurowski, Elizaveta V. Kuznetsova, Désirée Larenas-Linnemann, Marina S. Lebedkina, Youngsoo Lee, Michael P. Makris, René Maximiliano Gómez, Iman Nasr, Sophia Neisinger, Yoshiko Oda, Rabia Öztaş Kara, Esther Bastos Palitot, Niki Papapostolou, Claudio Alberto Salvador Parisi, David Pesque, Jonathan Peter, Elena Petkova, Katie Ridge, Michael Rudenko, Krzysztof Rutkowski, Sarbjit S. Saini, Andac Salman, Jorge Sanchez, Bülent Şekerel, Sofia A. Serdotetskova, Faradiba S. Serpa, Bahar Sevimli Dikicier, Nikitas Sidiropoulos, Agnieszka Sikora, Jennifer Astrup Sørensen, Angele Soria, Ozlem Su Kucuk, Sherin Rahim Thalappil, Katarzyna Tomaszewska, Gulseren Tuncay, Derya Unal, Solange Valle, Esmee van Lindonk, Christian Vestergaard, Aleksandr Vitchuk, Paraskevi Xepapadaki, Young Min Ye, Anna Zalewska-Janowska, Mateusz Zamlynski, Marcus Maurer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)

Abstract

Background: 

Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy.

Objective: 

We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination. 

Methods: 

COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters. 

Results: 

Across 2769 COVID-19–vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination–induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started <48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination–induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine–related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions. 

Conclusions: 

COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated.

Original languageEnglish
Pages (from-to)1095-1106
Number of pages12
JournalJournal of Allergy and Clinical Immunology
Volume152
Issue number5
DOIs
Publication statusPublished - Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 American Academy of Allergy, Asthma & Immunology

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