Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine A Case Series
Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine A Case Series
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DOI：
10.1001/jamadermatol.2021.1214
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发表时间：
2021-05-12
期刊：
影响因子：
10.9
通讯作者：
Little, Alicia J.
中科院分区：
文献类型：
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作者：
Johnston, Margaret S.;Galan, Anjela;Little, Alicia J.
重要性为了应对2019年冠状病毒病(新冠肺炎)大流行，2种信使核糖核酸疫苗(辉瑞-BioNTech和莫德纳)于2020年12月获得美国食品和药物管理局的紧急使用授权。目的描述现代新冠肺炎疫苗的局部皮肤注射反应的过程，并描述反应的组织病理学检查结果。设计、背景和对象这项回顾性的病例系列研究在耶鲁纽黑文医院进行，该医院是康涅狄格州纽黑文的一家三级医疗中心，从2021年1月20日到2月12日，16名有局部皮肤注射部位反应的患者被纳入研究结果和措施。我们收集了每个患者的人口统计信息，简要的相关病史，临床病程，和治疗(如有)；结果16例患者(年龄中位数38岁，25-89岁；女性13例，81%)，14例为白人，2例为亚洲人。迟发性局部皮肤反应在接种现代新冠肺炎疫苗后的中位数(范围)7(2-12)天内出现。这些反应发生在注射部位或附近，并被描述为瘙痒、疼痛和水肿性粉红色斑块。没有一名参与者接种过辉瑞-BioNTech疫苗。皮肤活检标本结果显示轻度混合浸润性淋巴细胞和嗜酸性粒细胞，主要分布在血管周围，符合皮肤过敏反应。在对第一剂疫苗有反应的参与者中(16名患者中的15名)，大多数(11名患者)对第二剂疫苗产生了类似的局部注射部位反应；大多数(10名患者)也比第一剂反应更早出现第二次反应。结论该病例系列研究的相关临床和组织病理学结果表明，对现代新冠肺炎疫苗的局部注射部位反应是一种迟发性超敏反应。这些反应可能在第二次接种后更早发生，但它们是自我限制的，与严重的疫苗不良反应无关。与即刻过敏反应(如过敏反应、荨麻疹)不同，这些延迟反应(被称为“冠状病毒臂”)并不是随后接种疫苗的禁忌症。
IMPORTANCE In response to the coronavirus disease 2019 (COVID-19) pandemic, 2 mRNA vaccines (Pfizer-BioNTech and Moderna) received emergency use authorization from the US Food and Drug Administration in December 2020. Some patients in the US have developed delayed localized cutaneous vaccine reactions that have been dubbed "COVID arm."OBJECTIVE To describe the course of localized cutaneous injection-site reactions to the Moderna COVID-19 vaccine, subsequent reactions to the second vaccine dose, and to characterize the findings of histopathologic examination of the reaction.DESIGN, SETTING, AND PARTICIPANTS This retrospective case series study was performed at Yale New Haven Hospital, a tertiary medical center in New Haven, Connecticut, with 16 patients referred with localized cutaneous injection-site reactions from January 20 through February 12, 2021.MAIN OUTCOMES AND MEASURES We collected each patient's demographic information, a brief relevant medical history, clinical course, and treatment (if any); and considered the findings of a histopathologic examination of 1 skin biopsy specimen.RESULTS Of 16 patients (median [range] age, 38 [25-89] years; 13 [81%] women), 14 patients self-identified as White and 2 as Asian. The delayed localized cutaneous reactions developed in a median (range) of 7 (2-12) days after receiving the Moderna COVID-19 vaccine. These reactions occurred at or near the injection site and were described as pruritic, painful, and edematous pink plaques. None of the participants had received the Pfizer-BioNTech vaccine. Results of a skin biopsy specimen demonstrated a mild predominantly perivascular mixed infiltrate with lymphocytes and eosinophils, consistent with a dermal hypersensitivity reaction. Of participants who had a reaction to first vaccine dose (15 of 16 patients), most (11 patients) developed a similar localized injection-site reaction to the second vaccine dose; most (10 patients) also developed the second reaction sooner as compared with the first-dose reaction.CONCLUSIONS AND RELEVANCE Clinical and histopathologic findings of this case series study indicate that the localized injection-site reactions to the Moderna COVID-19 vaccine are a delayed hypersensitivity reaction. These reactions may occur sooner after the second dose, but they are self-limited and not associated with serious vaccine adverse effects. In contrast to immediate hypersensitivity reactions (eg, anaphylaxis, urticaria), these delayed reactions (dubbed "COVID arm") are not a contraindication to subsequent vaccination.