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Miller MA, Raffetto ER, Lee RU. Chronic Spontaneous Urticaria Following mRNA COVID-19 Booster Vaccination at a Military Academy. Mil Med 2024; 189:e911-e914. [PMID: 37725042 DOI: 10.1093/milmed/usad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
Several adverse cutaneous reactions have been reported in the literature after SARS-CoV-2 vaccination with emerging reports on chronic spontaneous urticaria (CSU). However, there is little literature of chronic urticaria after COVID-19 boosters in a military population and the impact on operational readiness. We present a retrospective case series of CSU following Moderna COVID-19 booster vaccinations at the US Naval Academy (USNA). Demographics, clinical features, and impact on readiness were evaluated. Forty-nine students from the USNA were evaluated for urticaria after their third COVID-19 booster vaccination. Seventeen individuals were diagnosed with CSU. The median age was 20 years and predominantly male; the median time interval between vaccination and the onset of urticaria was 11 days. Out of 13 referred to Allergy, 7 patients had CU index performed and 2 were positive. Four patients received a second booster vaccination subsequently and did not have any exacerbation of symptoms. Symptoms were controlled with antihistamines, and none required immunomodulator or immunosuppressive therapies. All students were able to complete their commissioning, and none were referred for a medical board. In this series, USNA students who developed CSU after the mRNA COVID-19 Moderna booster vaccine did not have limitations from commissioning, duty status, or issues with subsequent COVID-19 vaccinations.
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Affiliation(s)
- Mechelle A Miller
- Allergy and Immunology Department, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA
| | | | - Rachel U Lee
- Allergy and Immunology Department, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA
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2
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Alcaraz-Serna A, Noto A, Ermellino L, Monzambani-Banderet V, Tommasini F, Stehlin F, Girard C, Perreau M, Muller YD. Basophil activation tests with cryopreserved mRNA-based COVID-19 vaccines. Allergol Int 2023; 72:600-603. [PMID: 37061390 PMCID: PMC10060195 DOI: 10.1016/j.alit.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/25/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023] Open
Affiliation(s)
- Ana Alcaraz-Serna
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Noto
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laura Ermellino
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique Monzambani-Banderet
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Francesco Tommasini
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florian Stehlin
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cedric Girard
- Pharmacy, University Hospital of Lausanne, Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthieu Perreau
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Pedro Brandão LG, Tuyama M, de Carvalho F, Taina da Silva Santos A, Lemos ADSD, Dias da Costa M, Mesquita EC, Cerbino-Neto J, Varela MC, Alvarenga Americano do Brasil PE, Rondon AV. Overdiagnosis of vaccine allergy: Skin testing and challenge at a public specialized unit (CRIE) in Rio de Janeiro, Brazil. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100101. [PMID: 37779527 PMCID: PMC10509850 DOI: 10.1016/j.jacig.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/09/2022] [Accepted: 01/03/2023] [Indexed: 10/03/2023]
Abstract
Background Vaccination is an extremely safe public health intervention, but rare IgE-mediated adverse events must be identified to avoid the risk of anaphylaxis in the event of reexposure. However, using only clinical history to diagnose previous allergic reactions may lead to overdiagnosis of vaccine allergy and even to the use of medical exemptions as a subterfuge to mandatory vaccination. Methods We conducted a retrospective study to describe the outcomes of patients with a history of vaccine or vaccine component allergy who were evaluated at our unit from 2011 to 2017. Data on allergy history, skin test results, vaccines prescribed, and adverse events were retrieved from the medical records at the Centro de Referência para Imunobiológicos Especiais (Reference Center of Special Immunobiologicals)-Fiocruz, in Rio de Janeiro, Brazil. Results Of 34 adults with history of allergy to vaccine or vaccine components, 32 (94.1%) were successfully vaccinated without serious adverse events after our evaluation. In 12 patients (35%), the time elapsed between the allergy symptoms and evaluation in the Centro de Referência para Imunobiológicos Especiais-Fiocruz was more than 10 years. Conclusion Specialized care and use of skin tests allowed safe vaccination of the majority of patients. An objective, systematic evaluation of a history of vaccine allergy can prevent its improper use to avoid mandatory vaccination and reduce missed opportunities for immunization.
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Affiliation(s)
- Luciana Gomes Pedro Brandão
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
- Health Surveillance and Immunization Research Unit, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | - Mari Tuyama
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | - Flávio de Carvalho
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | - Ananza Taina da Silva Santos
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | - Alberto dos Santos de Lemos
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
- Health Surveillance and Immunization Research Unit, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | - Marcellus Dias da Costa
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
- Health Surveillance and Immunization Research Unit, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | - Emersom Cicilini Mesquita
- Health Surveillance and Immunization Research Unit, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - José Cerbino-Neto
- Health Surveillance and Immunization Research Unit, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Margareth Catoia Varela
- Health Surveillance and Immunization Research Unit, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Angélica Varela Rondon
- Reference Center for Special Immunobiologicals, National Institute of Infectious Disease Evandro Chagas, Rio de Janeiro, Brazil
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Fallet B, Foglierini M, Porret R, Alcaraz A, Sauvage C, Jenelten R, Caplanusi T, Gilliet M, Perez L, Fenwick C, Genolet R, Harari A, Bobisse S, Gotardo R, Pantaleo G, Muller YD. Intradermal skin test with mRNA vaccines as a surrogate marker of T cell immunity in immunocompromised patients. J Infect 2023:S0163-4453(23)00329-8. [PMID: 37321353 DOI: 10.1016/j.jinf.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Intradermal skin test (IDT) with mRNA vaccines may represent a simple, reliable, and affordable tool to measure T cell response in immunocompromised patients who failed to mount serological responses following vaccination with mRNA covid-19 vaccines. METHODS We compared anti-SARS-CoV-2 antibodies and cellular responses in vaccinated immunocompromised patients (n=58), healthy seronegative naive controls (NC, n=8), and healthy seropositive vaccinated controls (VC, n=32) by Luminex, spike-induced IFN-γ Elispot and an IDT. A skin biopsy 24h after IDT and single-cell RNAseq was performed in three vaccinated volunteers. RESULTS Twenty-five percent of seronegative NC had a positive Elispot (2/8) and IDT (1/4), compared to 95% (20/21) and 93% (28/30) in seropositive VC, respectively. Single-cell RNAseq data in the skin of VC showed a predominant mixed population of effector helper and cytotoxic T cells. The TCR repertoire revealed 18/1064 clonotypes with known specificities against SARS-CoV-2, among which six were spike-specific. Seronegative immunocompromised patients with positive Elispot and IDT were in 83% (5/6) treated with B cell-depleting reagents, while those with negative IDT were all transplant recipients. CONCLUSIONS Our results indicate that delayed local reaction to IDT reflects vaccine-induced T-cell immunity opening new perspectives to monitor seronegative patients and elderly populations with waning immunity.
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Affiliation(s)
- Benedict Fallet
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Mathilde Foglierini
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Raphael Porret
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Ana Alcaraz
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Christophe Sauvage
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland
| | - Raphael Jenelten
- Department of Dermatology and venereology, University Hospital of Lausanne, Switzerland
| | - Teofila Caplanusi
- Department of Dermatology and venereology, University Hospital of Lausanne, Switzerland
| | - Michel Gilliet
- Department of Dermatology and venereology, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Laurent Perez
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Craig Fenwick
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Raphael Genolet
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland
| | - Alexandre Harari
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Sara Bobisse
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland
| | - Raphael Gotardo
- Biomedical Data Science Center, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland; Swiss Institute for Bioinformatics, Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
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Duperrex O, Tommasini F, Muller YD. Incidence of Chronic Spontaneous Urticaria Following Receipt of the COVID-19 Vaccine Booster in Switzerland. JAMA Netw Open 2023; 6:e2254298. [PMID: 36723944 PMCID: PMC9892951 DOI: 10.1001/jamanetworkopen.2022.54298] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This cohort study examines the association of the COVID-19 vaccine booster with chronic spontaneous urticaria in Swiss patients.
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Affiliation(s)
- Olivier Duperrex
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Francesco Tommasini
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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6
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Stehlin F, Tommasini F, Monzambani-Banderet V, Girard C, Yerly D, Ribi C, Muller YD. Graded-dosing immunization in adults at risk for immediate-type reactions to mRNA SARS-CoV-2 vaccines. Allergol Int 2022; 72:332-334. [PMID: 36280516 PMCID: PMC9595453 DOI: 10.1016/j.alit.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/17/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Florian Stehlin
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Francesco Tommasini
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Cedric Girard
- Pharmacy, University Hospital of Lausanne, Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Yerly
- Adverse Drug Reactions - Analysis & Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Yannick D. Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland,Corresponding author. Service d'immunologie et d'allergie, Département de médecine, BH010-511. Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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Pescosolido E, Muller YD, Sabaté‐Brescó M, Ferrer M, Yerly D, Caubet J, Lantin J, Ribi C, Bergmann MM. Clinical and immunological data from chronic urticaria onset after mRNA SARS-CoV-2 vaccines. Clin Exp Allergy 2022; 52:1343-1346. [PMID: 35962744 PMCID: PMC9539124 DOI: 10.1111/cea.14214] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Marina Sabaté‐Brescó
- Allergy Department, Clínica Universidad de NavarraIdiSNA, Navarra Institute for Health ResearchPamplonaNavarraSpain
| | - Marta Ferrer
- Allergy Department, Clínica Universidad de NavarraIdiSNA, Navarra Institute for Health ResearchPamplonaNavarraSpain
| | - Daniel Yerly
- Adverse Drug Reactions – Analysis and ConsultingBernSwitzerland
| | - Jean‐Christoph Caubet
- Pediatric Allergy Unit, Department of Woman, Child and AdolescentUniversity Hospitals of GenevaGenevaSwitzerland
| | | | - Camillo Ribi
- Service d'Immunologie et Allergie, CHUVLausanneSwitzerland
| | - Marcel M. Bergmann
- Centro Pediatrico del MendrisiottoMendrisioSwitzerland,Pediatric Allergy Unit, Department of Woman, Child and AdolescentUniversity Hospitals of GenevaGenevaSwitzerland,Faculty of Biomedical ScienceUniversità della Svizzera Italiana (USI)LuganoSwitzerland
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