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Moore A, Blumenthal KG, Chambers C, Namazy J, Nowak-Wegrzyn A, Phillips EJ, Rider NL. Improving Clinical Practice Through Patient Registries in Allergy and Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00470-7. [PMID: 38734373 DOI: 10.1016/j.jaip.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
Patient registries are a mechanism for collecting data on allergic and immunologic diseases that provide important information on epidemiology and outcomes that can ultimately improve patient care. Key criteria for establishing effective registries include the use of a clearly defined purpose, identifying the target population and ensuring consistent data collection. Registries in allergic diseases include those for diseases such as inborn errors of immunity (IEI), food allergy, asthma and anaphylaxis, pharmacological interventions in vulnerable populations, and adverse effects of pharmacologic interventions including hypersensitivity reactions to drugs and vaccines. Important insights gained from patient registries in our field include contributions in phenotype and outcomes in IEI, the risk for adverse reactions in food-allergic patients in multiple settings, the benefits and risk of biologic medications for asthma during pregnancy, vaccine safety, and the categorization and genetic determination of risk for severe cutaneous adverse reactions to medications. Impediments to the development of clinically meaningful patient registries include the lack of funding resources for registry establishment and the quality, quantity, and consistency of available data. Despite these drawbacks, high-quality and successful registries are invaluable in informing clinical practice and improving outcomes in patients with allergic and immunological diseases.
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Affiliation(s)
- Andrew Moore
- ENTAA Care, Johns Hopkins Regional Physicians, Glen Burnie, Md.
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, Calif
| | - Jennifer Namazy
- Division of Allergy and Immunology, Scripps Clinic, La Jolla, Calif
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Elizabeth J Phillips
- Department of Medicine, Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Nicholas L Rider
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Va; Carilion Clinic, Section of Allergy-Immunology, Roanoke, Va
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2
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Bataille P, Lebrun-Vignes B, Bettuzzi T, Ingen-Housz-Oro S, Hadj-Rabia S, Welfringer-Morin A, Bodemer C. Drugs associated with epidermal necrolysis in children: A World Health Organization pharmacovigilance database analysis. J Eur Acad Dermatol Venereol 2024. [PMID: 38682703 DOI: 10.1111/jdv.20054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening mucocutaneous reactions most often induced by drugs. To date, no large pharmacovigilance study has been conducted in the paediatric population. OBJECTIVES To describe the spectrum of drugs associated with SJS-TEN in children through the analysis of cases reported in the WHO pharmacovigilance database (VigiBase). METHODS Disproportionality study using data from VigiBase. All paediatric (age under 18 years) cases reported between January 1, 1967, and July 6, 2022, were included. For each molecule, a case-non-case study was performed to assess a potential pharmacovigilance signal by computing the lower end of the 95% credibility interval for the information component (IC025). We performed sensitivity analyses, (i) taking into account only cases reported by physicians and (ii) taking into account only cases reported in the last 10 years. RESULTS Among 31,376,783 adverse drug reactions reported in VigiBase, 2,248,727 were paediatric cases and 7342 were encoded as paediatric SJS-TEN. Significant statistical pharmacovigilance signals were observed for 165 drugs. The two most represented drug classes were antiepileptics and anti-infectious drugs. The five drugs with the highest IC025 were lamotrigine (IC025 4.99), carbamazepine (IC025 4.88), phenobarbital (IC025 4.67), phenytoin (IC025 4.52) and nimesulide (IC025 4.23). Acetaminophen was significantly associated with paediatric SJS-TEN (IC025 2.85) and we also described various new suspected drugs. Vaccines had no significant pharmacovigilance signal. These results were confirmed with the sensitivity analyses. CONCLUSIONS This study updates the spectrum of drugs potentially associated with paediatric SJS-TEN.
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Affiliation(s)
- Pauline Bataille
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Paris City University, Imagine Institute, Data Science Platform, INSERM UMR 1163, Paris, France
| | - Benedicte Lebrun-Vignes
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Regional Pharmacovigilance Center, Department of Pharmacology, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Est Créteil EpidermE, UPEC, Créteil, France
| | - Thomas Bettuzzi
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Regional Pharmacovigilance Center, Department of Pharmacology, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Est Créteil EpidermE, UPEC, Créteil, France
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Université Paris Est Créteil EpidermE, UPEC, Créteil, France
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Smail Hadj-Rabia
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Anne Welfringer-Morin
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Christine Bodemer
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
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Alghamdi Y, Abdulghani F, Huwait HF, Abdulghani M, Samarkandy SJ. An Unusual Presentation of Erythema Multiforme Following the Administration of Pfizer-BioNTech COVID-19 mRNA Vaccine in a Pediatric Patient. Cureus 2024; 16:e58450. [PMID: 38765345 PMCID: PMC11100275 DOI: 10.7759/cureus.58450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused a global calamity that forced emergency use authorization to Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. It is efficacious in preventing symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in seronegative recipients. The safety profile is still unclear; however, commonly reported symptoms post-vaccination are fatigue, headache, muscle pain, chills, and injection-site pain. COVID-19 disease elicits, to some extent, cutaneous side effects like urticaria, morbilliform rash, and chilblain-like eruption. Vaccination against COVID-19 was reported to induce similar dermatologic manifestations, such as urticarial rash, delayed large-local reaction, local injection-site reaction, and morbilliform eruption. Erythema multiforme (EM) is a rare manifestation post-vaccination, and only a few reports implicate it as a culprit in cutaneous eruptions following the BNT162b2 vaccine. This report delineates the presentation of a healthy 14-year-old girl to a dermatology clinic who developed EM post-vaccination with the first dose of BNT162b2. New-onset EM-eruption post-vaccination with BNT162b2 had been reported previously in 14 cases, and one case reported on the flare of preexisting-EM.
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Affiliation(s)
- Yara Alghamdi
- Dermatology, King Abdullah Medical Complex, Ministry of Health, Jeddah, SAU
| | | | | | | | - Sahal J Samarkandy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Dermatology, King Abdulaziz Medical City (KAMC), Jeddah, SAU
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Gubernot D, Menis M, Whitaker B. Background rates for severe cutaneous reactions in the US: Contextual support for safety assessment of COVID-19 vaccines and novel biologics. Vaccine 2023; 41:6922-6929. [PMID: 37891051 DOI: 10.1016/j.vaccine.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The global COVID-19 public health crisis has resulted in extraordinary collaboration to expeditiously develop vaccines and therapeutics. The safety of these biologics is closely monitored by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Novel products may have limited safety data, and although serious medical outcomes associated with vaccination are rare, knowledge of background incidence rates of medical conditions in the US population puts reported adverse events (AEs) in perspective for further study. Although relatively minor vaccination skin reactions are common, rare instances of severe delayed hypersensitivity reactions such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome may occur. To aid in the assessment of these events, we performed a literature search in PubMed and Web of Science on the background incidence of EM, SJS, SJS/TEN, and TEN in the US population and on published reports of these conditions occurring post-vaccination. The US background annual incidence rates per million individuals of all ages ranged from 5.3 to 63.0 for SJS, from 0.4 to 5.0 for TEN, and from 0.8 to 1.6 for SJS/TEN. Since these conditions may overlap, some studies reported rates for EM/SJS/TEN combined, however we did not find studies with exclusive EM incidence rates. The published literature, including studies of reports submitted to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS), describes post-vaccination EM, SJS, SJS/TEN and/or TEN as rare occurrences. The vaccines most frequently associated with these conditions were measles, mumps, and rubella; diphtheria, tetanus, and pertussis; and varicella. The majority of VAERS reports of EM, SJS, SJS/TEN, or TEN occurred in children within 30 days of vaccination. This review summarizes background rates of these disorders in the general population and published AEs among vaccine recipients, to support safety surveillance of COVID-19 vaccines and other biologics.
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Affiliation(s)
- Diane Gubernot
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Mikhail Menis
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
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5
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Fok JS, Katelaris CH. Urticaria and mimickers of urticaria. FRONTIERS IN ALLERGY 2023; 4:1274031. [PMID: 37841054 PMCID: PMC10569303 DOI: 10.3389/falgy.2023.1274031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Urticaria is a common skin condition encountered across various specialties in medicine, especially in dermatology and allergy/immunology practice. It has a heterogeneous presentation hence it is unsurprising that many skin conditions may be confused with urticaria. Urticaria may present as acute or chronic urticaria, the latter can be further categorised into chronic spontaneous and chronic inducible. In this article, we explore, explain, and summarise various skin lesions that are considered mimickers of urticaria, to promote understanding of each of the conditions highlighted, improve recognition, and reduce misdiagnosis.
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Affiliation(s)
- Jie Shen Fok
- Department of Respiratory Medicine and General Medicine, Box Hill Hospital, Eastern Health, Melbourne, VIC, Australia
- Monash Lung, Sleep and Allergy/Immunology, Monash Medical Centre, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Constance H. Katelaris
- Department of Medicine, Immunology and Allergy Unit, Campbelltown Hospital, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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6
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Lee HJ, Yun SY, Choi JY, Lee YB. Stevens-Johnson Syndrome Following ChAdOx1 nCoV-19 Vaccination (AstraZeneca). Ann Dermatol 2023; 35:S170-S172. [PMID: 37853902 PMCID: PMC10608388 DOI: 10.5021/ad.21.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/07/2021] [Accepted: 11/04/2021] [Indexed: 10/20/2023] Open
Affiliation(s)
- Hyo Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Yeon Yun
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Young Choi
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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7
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Ahouach B, Diaz E, Bertin B, Ben Said B, Combret S, Grandvuillemin A, Petitpain N, Rabier MB, Thomas L, Trenque T, Ingen-Housz-Oro S, Lebrun-Vignes B. Epidermal necrolysis after COVID-19 vaccination: An exploratory analysis using World Health Organization VigiBase. J Eur Acad Dermatol Venereol 2023; 37:e456-e459. [PMID: 36606525 DOI: 10.1111/jdv.18845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Btisseme Ahouach
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France
| | - Emmanuelle Diaz
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France
| | - Blandine Bertin
- Pharmacovigilance Center, Hospital University Pharmacotoxicology Department, Hospices Civils de Lyon HCL, Lyon, France
| | - Benoit Ben Said
- Dermatology Department, Edouard Herriot Hospital, Lyon, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Sandrine Combret
- Pharmacovigilance Department, Dijon University Hospital, Dijon, France
| | | | - Nadine Petitpain
- Pharmacovigilance Department, Nancy-Brabois Hospital, Vandoeuvre-lès-Nancy, France
| | | | - Laure Thomas
- Pharmacovigilance Department, Henri-Mondor Hospital AP-HP, Créteil, France
| | - Thierry Trenque
- Pharmacovigilance Department, University Hospitals of Reims, Reims, France
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Univ Paris Est Créteil Epiderme, UPEC, Créteil, France
| | - Bénédicte Lebrun-Vignes
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Univ Paris Est Créteil Epiderme, UPEC, Créteil, France.,Pharmacovigilance Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
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8
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Yousefian M, Khadivi A. Occurrence of erythema multiforme following COVID-19 vaccination: a review. Clin Exp Vaccine Res 2023; 12:87-96. [PMID: 37214146 PMCID: PMC10193109 DOI: 10.7774/cevr.2023.12.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/02/2023] [Indexed: 05/24/2023] Open
Abstract
The fast development of vaccines against the novel coronavirus disease is among the most critical steps taken to control this potentially fatal viral disease. Like other vaccines, the coronavirus disease 2019 (COVID-19) vaccines can also cause unwanted reactions. Erythema multiforme (EM) is among the oral mucocutaneous side effects of COVID-19 vaccines. This study aimed to comprehensively review the reported cases of EM since the global onset of COVID-19 vaccination. Data from 31 relevant studies regarding the type and dose of COVID-19 vaccines administered, time of initiation of symptoms, age, and gender of patients, site of involvement, patients' medical history, and treatment options were extracted. In total, 90 patients were identified with EM as a side effect of COVID-19 vaccination across studies. EM had the highest frequency after receiving the first dose of mRNA vaccines in older individuals. The first symptoms of EM appeared in less than 3 days in 45% and after 3 days in 55% of patients. EM is not a common side effect of COVID-19 vaccination, and fear of its occurrence should not impede vaccination.
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Affiliation(s)
- Marzieh Yousefian
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Alireza Khadivi
- School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
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9
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Jue MS, Joh HC, Kim SH, Ko JY. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap After the Third Dose of BNT162b2 mRNA COVID-19 Vaccination and Literature Review. Dermatitis 2023; 34:158-159. [PMID: 36716204 DOI: 10.1089/derm.2022.29003.msj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Mihn-Sook Jue
- Department of Dermatology, Hanyang University Hospital, Seoul, Korea
| | - Hae Chang Joh
- Department of Dermatology, Hanyang University Hospital, Seoul, Korea
| | - Sang Heon Kim
- Department of Dermatology, Hanyang University Hospital, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University Hospital, Seoul, Korea
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10
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Karatas E, Nazim A, Patel P, Vaidya T, Drew GS, Amin SA, Keyes AA, Fonseca M, Mir A, Halverstam CP. Erythema multiforme reactions after Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) COVID-19 vaccination: A case series. JAAD Case Rep 2023; 32:55-58. [PMID: 35097177 PMCID: PMC8786602 DOI: 10.1016/j.jdcr.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Elif Karatas
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ali Nazim
- Ross University School of Medicine, Bridgetown, Barbados
| | - Parth Patel
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Toral Vaidya
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | | | | | - Ashley A. Keyes
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Maira Fonseca
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Adnan Mir
- Dermpath Diagnostics, Port Chester, New York
| | - Caroline P. Halverstam
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York,Correspondence to: Caroline P. Halverstam, MD, Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Bainbridge Avenue, 2nd Floor, Bronx, NY 10467
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11
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Mohseni Afshar Z, Tavakoli Pirzaman A, Liang JJ, Sharma A, Pirzadeh M, Babazadeh A, Hashemi E, Deravi N, Abdi S, Allahgholipour A, Hosseinzadeh R, Vaziri Z, Sio TT, Sullman MJM, Barary M, Ebrahimpour S. Do we miss rare adverse events induced by COVID-19 vaccination? Front Med (Lausanne) 2022; 9:933914. [PMID: 36300183 PMCID: PMC9589063 DOI: 10.3389/fmed.2022.933914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused many complications, the invention of coronavirus disease 2019 (COVID-19) vaccines has also brought about several adverse events, from common side effects to unexpected and rare ones. Common vaccine-related adverse reactions manifest locally or systematically following any vaccine, including COVID-19 vaccines. Specific side effects, known as adverse events of particular interest (AESI), are unusual and need more evaluation. Here, we discuss some of the most critical rare adverse events of COVID-19 vaccines.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Jackson J. Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, United States
| | - Akanksha Sharma
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
| | - Marzieh Pirzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Erfan Hashemi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadaf Abdi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Amirreza Allahgholipour
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Vaziri
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Mark J. M. Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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12
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Lestari W, Vella V, Yasir T, Zulfikar T. Case Report: A successful case of toxic epidermal necrolysis treated with plasmapheresis therapy. F1000Res 2022; 11:995. [PMID: 37128216 PMCID: PMC10148083 DOI: 10.12688/f1000research.125050.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Toxic epidermal necrosis (TEN) is rare and can be life-threatening for patients. Appropriate management of TEN patients could give optimal results and prevent complications. One treatment modality for TEN is plasmapheresis, which is rarely available in most cases with severe TEN. Here we reported a successful treatment of severe TEN with plasmapheresis. A 40-year-old woman under tuberculosis therapy complained of shortness of breath that began four days prior to hospital admission and worsened ever since. The patient's skin was peeling with red spots and rashes all over the body for a week. During the examination, the patient was compos mentis, and the SCORTEN score was 2 with 12.1% risk of mortality rate. Dermatological examination of the face, trunk and extremities found extensive erosions, loose bullae filled with clear fluid, brown crusts, and generalized distribution with more than 30% epidermolysis. The patient was diagnosed with toxic epidermal necrolysis caused by antituberculosis therapy. We treated the patient by discontinuing the suspected drugs and administering the corticosteroids, but no improvement was observed. The patient underwent two cycle plasmaphereses with 5% albumin, resulting in 1.2 liter of plasma exchange. Re-epithelialization was observed after three days, and the patient was discharged on day 8. This case-report highlights the important role of plasmapheresis in treating the TEN patients. However, a study with larger sample sizes is warranted to validate the efficacy of plasmapheresis in TEN.
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Affiliation(s)
- Wahyu Lestari
- Department of Dermato-Venereology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Dermato-Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Vella Vella
- Department of Dermato-Venereology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Dermato-Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Teuku Yasir
- Department of Anesthesiology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Anesthesiology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Teuku Zulfikar
- Department of Pulmonology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Pulmonology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
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Stevens-Johnson syndrome in children. Curr Opin Pediatr 2022; 34:341-348. [PMID: 35836393 DOI: 10.1097/mop.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The concept of Stevens-Johnson syndrome (SJS) in children is evolving. This manuscript reviews recent advances with the lens of new terminology namely infection-triggered reactive infectious mucocutaneous eruption and drug-induced epidermal necrolysis, with the objective of integrating this novel terminology practically. RECENT FINDINGS Traditionally considered to exist on a spectrum with toxic epidermal necrolysis, SJS in children is more often caused or triggered by infections instead of medications. Proposed pediatric-specific terminology can be applied to literature to gain further insights into blistering severe cutaneous adverse reactions. SUMMARY Distinguishing infection-triggered from drug-triggered blistering reactions is useful for 3 main reasons: (1) early clinically recognizable different features such as isolated or predominant mucositis, (2) different initial management depending on trigger, (3) avoiding the label of a drug reaction on cases triggered by infection.
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14
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Seck B, Dieye A, Diallo M. Lethal Toxic Epidermal Necrolysis probably induced by Sinopharm COVID-19 vaccine. REVUE FRANÇAISE D'ALLERGOLOGIE 2022; 62:590-592. [PMID: 35855853 PMCID: PMC9276642 DOI: 10.1016/j.reval.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/07/2022] [Indexed: 10/25/2022]
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15
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Castillo JG, Gibert PR, Romero Abrio C, Parrón AM, Iglesias Martínez E, Arrue Michelena I, García Río I. "Erythema Multiforme after the third dose of mRNA-1273". Dermatol Ther 2022; 35:e15497. [PMID: 35388597 DOI: 10.1111/dth.15497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Pau Rosés Gibert
- Department of Dermatology, Hospital Universitario Araba, Vitoria, Spain
| | | | | | | | | | - Irene García Río
- Department of Dermatology, Hospital Universitario Araba, Vitoria, Spain
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16
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Nazir A, Ali K. Drug induced erythema multiforme-oral variant: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2021.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Iwasawa O, Kamiya K, Komine M, Ohtsuki M. Case of atypical erythema multiforme following coronavirus disease 2019 vaccination. J Dermatol 2021; 49:e113-e114. [PMID: 34821413 DOI: 10.1111/1346-8138.16255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Okuto Iwasawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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18
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Kherlopian A, Zhao C, Ge L, Forward E, Fischer G. A case of toxic epidermal necrolysis after ChAdOx1 nCov-19 (AZD1222) vaccination. Australas J Dermatol 2021; 63:e93-e95. [PMID: 34751429 PMCID: PMC8653013 DOI: 10.1111/ajd.13742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/24/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Ashod Kherlopian
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Cathy Zhao
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ludi Ge
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Emily Forward
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gayle Fischer
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
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19
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[Erythema multiforme following COVID-19 vaccination (BNT162b2)]. Hautarzt 2021; 73:68-70. [PMID: 34676438 PMCID: PMC8530369 DOI: 10.1007/s00105-021-04911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/14/2022]
Abstract
Es wird über den Fall eines ausgeprägten Erythema exsudativum multiforme infolge einer COVID-19-Impfung berichtet. Die Effloreszenzen an Haut und Schleimhaut entwickelten sich 48 h nach der zweiten Dosis des mRNA-Impfstoffs BNT162b2 (Tozinameran, Comirnaty®). Unter der Anwendung glukokortikoidhaltiger Externa kam es innerhalb von 3 Wochen zu einer folgenlosen Abheilung.
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20
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Kim MJ, Kim JW, Kim MS, Choi SY, Na JI. Generalized erythema multiforme-like skin rash following the first dose of COVID-19 vaccine (Pfizer-BioNTech). J Eur Acad Dermatol Venereol 2021; 36:e98-e100. [PMID: 34661942 PMCID: PMC8656619 DOI: 10.1111/jdv.17757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Affiliation(s)
- M J Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - J W Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - M S Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - S Y Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Korea
| | - J I Na
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
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21
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Saibene AM, Alliata A, Cozzi AT, Ottavi A, Spagnolini S, Pipolo C, Maccari A, Felisati G. Erythema Multiforme Major following SARS-CoV-2 vaccine. Clin Case Rep 2021; 9:e04947. [PMID: 34667612 PMCID: PMC8512181 DOI: 10.1002/ccr3.4947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
Erythema multiforme major, an immune-mediated skin reaction to infections or medications with oral involvement, should be taken into account as a potential side effect of several vaccines, including SARS-CoV-2. Correct patient history collection allows prompt recognition and subsequent successful medical management with oral corticosteroids.
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Affiliation(s)
- Alberto Maria Saibene
- Otolaryngology UnitSanti Paolo e Carlo HospitalDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Andrea Alliata
- Otolaryngology UnitSanti Paolo e Carlo HospitalDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Anna Teresa Cozzi
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Alice Ottavi
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Sofia Spagnolini
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Carlotta Pipolo
- Otolaryngology UnitSanti Paolo e Carlo HospitalDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Alberto Maccari
- Otolaryngology UnitSanti Paolo e Carlo HospitalDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Giovanni Felisati
- Otolaryngology UnitSanti Paolo e Carlo HospitalDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
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22
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Buján Bonino C, Moreiras Arias N, López-Pardo Rico M, Pita da Veiga Seijo G, Rosón López E, Suárez Peñaranda JM, Sánchez-Aguilar Rojas D. Atypical erythema multiforme related to BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Int J Dermatol 2021; 60:e466-e467. [PMID: 34473839 PMCID: PMC8652986 DOI: 10.1111/ijd.15894] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Cecilia Buján Bonino
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Noelia Moreiras Arias
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María López-Pardo Rico
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Elena Rosón López
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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23
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Elboraey MO, Essa EESF. Stevens-Johnson syndrome post second dose of Pfizer COVID-19 vaccine: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e139-e142. [PMID: 34384729 PMCID: PMC8288232 DOI: 10.1016/j.oooo.2021.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) began in December 2019 and has affected millions of people all over the world. Respiratory illness in the form of severe pneumonia, in addition to multiorgan failure and death, is the clinical spectrum of COVID-19. Although there are no specific therapeutic agents for COVID-19 infection, the COVID-19 vaccine reduces morbidity and mortality associated with COVID-19 infection and is generally well tolerated. We report one potential complication of the Pfizer COVID-19 vaccine: a known case of Stevens-Johnson syndrome (SJS) that occurred after the second dose of the Pfizer COVID-19 vaccine alone without exposure to any other drug. Despite the initial severe adverse reaction, the patient showed a full recovery. Although SJS can be associated with COVID-19 vaccination, it is rare, and the benefits of receiving the vaccination outweigh the potential harms.
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Affiliation(s)
- Mohamed Omar Elboraey
- Lecturer of Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Tanta University, Tanta, Egypt; Assistant Professor of Periodontology Department, College of Dentistry, Taibah University, Al Medinah, Kingdom of Saudi Arabia.
| | - Emad El Said Fahim Essa
- Assistant Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Tanta, Egypt; Associate Professor of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Al Medinah, Kingdom of Saudi Arabia
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24
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Lopes NT, Pinilla CEO, Gerbase AC. Erythema multiforme after CoronaVac vaccination. J Eur Acad Dermatol Venereol 2021; 35:e717-e719. [PMID: 34236724 PMCID: PMC8446988 DOI: 10.1111/jdv.17495] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N T Lopes
- Dermatology Service of Ambulatório de Dermatologia Sanitária (ADS), Porto Alegre, Brazil
| | | | - A C Gerbase
- Geneva Foundation for Medical Education and Research - GFMER, Geneva, Switzerland
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25
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Kong J, Cuevas-Castillo F, Nassar M, Lei CM, Idrees Z, Fix WC, Halverstam C, Mir A, Elbendary A, Mathew A. Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report. J Infect Public Health 2021; 14:1392-1394. [PMID: 34294590 PMCID: PMC8264280 DOI: 10.1016/j.jiph.2021.06.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background In December 2020, Moderna released the mRNA-1273 vaccine. The most common side effects are headache, muscle pain, redness, swelling, and tenderness at the injection site. In addition, there have been dermatological adverse events, such as hypersensitivity reactions. Although rare, various bullous eruptions have been described following vaccination. Bullous pemphigoid has been reported to occur most often after receipt of influenza and the diphtheria-tetanus-pertussis vaccine. To the best of our knowledge, there have been no reports of bullous drug eruptions resulting from mRNA vaccines. Case summary A 66-years-old obese Guyanese male presented with a bullous rash following receipt of a commercial COVID-19 mRNA vaccine. He received the first dose uneventfully. However, within 24 h of receiving the second dose, he developed fever, myalgias, and malaise accompanied by a painful blistering rash of his torso, arms, and legs. His fever and myalgias improved after 24 h, but his painful rash did not, and five days after the initial symptoms, he presented to the hospital. There were many violaceous, poorly demarcated patches on his trunk, arms, and thighs on examination, many of which had large flaccid bullae within, and a few areas on his buttocks, posterior shoulder, and scrotum were eroded. The exam was also significant for lower extremity muscle tenderness, stiffness with preserved strength. A skin biopsy showed epidermal necrosis and sparse perivascular dermatitis concerning Stevens-Johnson syndrome or erythema multiforme. However, in the absence of mucous membrane involvement or targetoid lesions, the diagnosis of an extensive bullous fixed drug eruption was made. Conclusion This case illustrates that the bullae eruption occurred as a result of receiving the Moderna vaccination.
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Affiliation(s)
- Joyce Kong
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | | | - Mahmoud Nassar
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | - Chi M Lei
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | - Zarwa Idrees
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
| | - William C Fix
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Caroline Halverstam
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Adnan Mir
- Dermpath Diagnostics, Weill Cornell Medicine Department of Dermatology, and New York Medical College Department of Dermatology, White Plains, NY, USA.
| | - Amira Elbendary
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Alwin Mathew
- Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
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26
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Alpalhão M, Maia-Silva J, Filipe P. Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines and Cutaneous Adverse Reactions: A Review. Dermatitis 2021; 32:133-139. [PMID: 33851937 DOI: 10.1097/der.0000000000000755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We are entering a new stage of the severe acute respiratory syndrome coronavirus 2 pandemic with the initiation of large-scale vaccination programs globally. In these circumstances, even rare adverse effects of vaccines may be encountered more often, if millions of people are to be vaccinated in a short period. Vaccination has the potential for causing cutaneous adverse effects. Thus, it is paramount that dermatologists worldwide are acquainted with the possible skin reaction patterns to the coming vaccines. Herein, we conduct a review to discuss the most frequent cutaneous adverse effects of vaccines and their management, with a particular focus on the expected adverse reactions for the coming severe acute respiratory syndrome coronavirus 2 vaccines, such as local reactions, as well as immediate- and delayed-type hypersensitivity reactions, including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrosis, serum sickness-like reactions, and vasculitides. We also discuss the yet unanswered questions on vaccines for which we may soon be asked to provide an expert opinion.
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27
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Cheng L. Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Front Pharmacol 2021; 12:588063. [PMID: 33981213 PMCID: PMC8107822 DOI: 10.3389/fphar.2021.588063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?
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Affiliation(s)
- Lin Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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