Skin Adverse Reactions to Novel Messenger RNA Coronavirus Vaccination: A Case Series

Vaccines are actually the most effective strategy to control the COVID-19 spread and reduce mortality, but adverse reactions can occur. Skin involvement with novel messenger RNA coronavirus vaccines seems frequent but is not completely characterized. A real-world experience in the recent vaccination campaign among health care workers in Sardinia (Italy) is reported. In over a total of 1577 persons vaccinated, 9 cases of skin adverse reactions were observed (0.5%). All reactions have been reported to the Italian Pharmacovigilance Authority. Eight occurred in women (mean age 46 years), and five were physicians and four nurses. All patients had a significant allergology history but not for the known vaccine excipients. After dose one, no injection site reactions were observed, but widespread pruritus (n = 3), mild facial erythema (n = 1), and maculopapular rash (n = 3) occurred in the following 24–48 h in three patients. These three patients were excluded from the second dose. Of the remaining six patients, one developed mild anaphylaxis within the observation period at the vaccination hub and five delayed facial erythematous edema and maculopapular lesions, requiring antihistamines and short-course corticosteroid treatment. Spontaneous reporting is paramount to adjourning vaccination guidance and preventive measures in order to contribute to the development of a safe vaccine strategy. Dermatologist’ expertise might provide better characterization, treatment, and screening of individuals at high risk of skin adverse reactions.

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Case Series of Three Patients with Rifampicin-Induced Thrombocytopenia

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1718608 ◽

2020 ◽

Author(s):

Chandramouli M.T

Keyword(s):

Pulmonary Tuberculosis ◽

Adverse Reactions ◽

Rare Complication ◽

Case Series ◽

Tuberculosis Treatment ◽

Effective Drug ◽

Antitubercular Drugs ◽

Short Course ◽

Life Threatening

AbstractLife-threatening adverse reactions of antitubercular drugs are uncommon; however, thrombocytopenia is one such rare complication encountered with rifampicin, isoniazid, ethambutol, and pyrazinamide. Rifampicin is the most effective drug and its use in the tuberculosis treatment led to the emergence of modern and effective short-course regimens. I am reporting case series of three patients with pulmonary tuberculosis presented with rifampicin-induced thrombocytopenia.

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Delayed systemic urticarial reactions following mRNA COVID-19 vaccination

Allergy and Asthma Proceedings ◽

10.2500/aap.2022.43.210101 ◽

2022 ◽

Vol 43 (1) ◽

pp. 40-43 ◽

Cited By ~ 1

Author(s):

Mitchell M. Pitlick ◽

Avni Y. Joshi ◽

Alexei Gonzalez-Estrada ◽

Sergio E. Chiarella

Keyword(s):

Messenger Rna ◽

Skin Testing ◽

Vaccination Campaign ◽

Case Series ◽

Vaccine Dose ◽

Retrospective Case ◽

Life Threatening ◽

History Of ◽

The Mean ◽

To Receive

Background: As the vaccination campaign in response to the coronavirus disease 2019 (COVID-19) pandemic continues, concerns with regard to adverse reactions to the vaccine remain. Although immediate hypersensitivity reactions have received much attention, delayed systemic urticarial reactions after vaccination can occur. Objective: To describe the clinical presentation, vaccine excipient skin testing results, and outcomes of subsequent COVID-19 vaccination in patients who experienced delayed systemic urticarial reactions after messenger RNA (mRNA) COVID-19 vaccination. Methods: This was a retrospective case series of 12 patients referred to the Mayo Clinics in Rochester, Minnesota, and Jacksonville, Florida, between January 19, 2021, and April 30, 2021, for evaluation of delayed systemic urticarial reactions after mRNA COVID-19 vaccination. Demographics, medical and allergic history, reaction details, vaccine excipient skin testing results (when performed), and the outcome after subsequent vaccination were collected for each patient. Results: The mean age of the patients was 52 years, all were white, and 9 (75%) were women. Half of the patients had a history of drug allergy, and one had a history of chronic spontaneous urticaria. Seven patients reacted to the Pfizer-BioNTech vaccine and five reacted to the Moderna vaccine. Seven patients developed symptoms between 8 and 24 hours after vaccination. Nine patients required antihistamines for treatment. The median time to symptom resolution was 4 days. Nine patients underwent allergist-directed COVID-19 vaccine excipient skin testing, all of which were negative. Ten patients chose to receive their next mRNA COVID-19 vaccine dose, and four patients experienced recurrent delayed urticaria. Conclusion: Delayed systemic urticarial reactions after mRNA COVID-19 vaccination were not life-threatening, could be treated with antihistamines, and were not predicted with vaccine excipient skin testing. They were not a contraindication to subsequent vaccination, although patients should be counseled with regard to the possibility of recurrence.

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Zolpidem for Insomnia: A Double-Edged Sword. A Systematic Literature Review on Zolpidem-Induced Complex Sleep Behaviors

Indian Journal of Psychological Medicine ◽

10.1177/0253717621992372 ◽

2021 ◽

pp. 025371762199237

Author(s):

Niti Mittal ◽

Rakesh Mittal ◽

M. C. Gupta

Keyword(s):

Adverse Reactions ◽

Case Reports ◽

Case Series ◽

Eligibility Criteria ◽

Study Objective ◽

Spontaneous Reports ◽

Cochrane Database ◽

Sleep Behaviors ◽

Therapeutic Doses ◽

Favorable Side Effect Profile

Background: Being a nonbenzodiazepine, zolpidem is believed to have a favorable side-effect profile and is widely prescribed for insomnia. However, in the past few years, numerous neuropsychiatric adverse reactions, particularly complex sleep behaviors (CSBs), have been reported with zolpidem. Objective: To conduct a systematic review of zolpidem-associated CSBs. Data Sources: An electronic search was conducted using MEDLINE, Embase, PubMed, and Cochrane database of systematic reviews to extract relevant articles till July 2020. Study Eligibility Criteria: Any type of literature article (case report, case series, and observational or interventional study) reporting CSBs associated with zolpidem. Results: In this review, we present aggregate summarized data from 148 patients presenting with zolpidem-induced CSBs (79 patients from 23 case reports and 5 case series; 69 patients out of 1454 taking zolpidem [4.7%] from three observational clinical studies). Various types of CSBs associated with zolpidem were reported, most common being sleepwalking/somnambulism and sleep-related eating disorder. On causality assessment, around 88% of cases were found to have a probable association with zolpidem. Limitations: Extraction of data from observational studies and spontaneous reports, due to nonavailability of any randomized controlled trials relevant to the study objective. Conclusion and Implication of Key Findings: Zolpidem-induced CSBs, although not very common, may develop when the drug is used at therapeutic doses for insomnia. Doctors need to be alert to monitor such adverse effects of zolpidem and exercise caution while prescribing it.

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Resources, Production Scales and Time Required for Producing RNA Vaccines for the Global Pandemic Demand

Vaccines ◽

10.3390/vaccines9010003 ◽

2020 ◽

Vol 9 (1) ◽

pp. 3

Author(s):

Zoltán Kis ◽

Cleo Kontoravdi ◽

Robin Shattock ◽

Nilay Shah

Keyword(s):

Production Process ◽

Messenger Rna ◽

Vaccination Campaign ◽

Vaccine Dose ◽

Economic Feasibility ◽

Small Scale ◽

Production Scale ◽

Working Volume ◽

Global Demand ◽

The Impact

To overcome pandemics, such as COVID-19, vaccines are urgently needed at very high volumes. Here we assess the techno-economic feasibility of producing RNA vaccines for the demand associated with a global vaccination campaign. Production process performance is assessed for three messenger RNA (mRNA) and one self-amplifying RNA (saRNA) vaccines, all currently under clinical development, as well as for a hypothetical next-generation saRNA vaccine. The impact of key process design and operation uncertainties on the performance of the production process was assessed. The RNA vaccine drug substance (DS) production rates, volumes and costs are mostly impacted by the RNA amount per vaccine dose and to a lesser extent by the scale and titre in the production process. The resources, production scale and speed required to meet global demand vary substantially in function of the RNA amount per dose. For lower dose saRNA vaccines, global demand can be met using a production process at a scale of below 10 L bioreactor working volume. Consequently, these small-scale processes require a low amount of resources to set up and operate. RNA DS production can be faster than fill-to-finish into multidose vials; hence the latter may constitute a bottleneck.

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Cochlear Implant Outcomes in Patients with Neurosarcoidosis

Audiology and Neurotology ◽

10.1159/000514479 ◽

2021 ◽

pp. 1-7

Author(s):

Dario Ebode ◽

Fleur Cohen-Aubart ◽

Stéphanie Trunet ◽

Evelyne Ferrary ◽

Ghizlène Lahlou ◽

...

Keyword(s):

Hearing Loss ◽

Cochlear Implantation ◽

Case Series ◽

Corticosteroid Treatment ◽

Auditory Neuropathy ◽

Disease Exacerbation ◽

Profound Hearing Loss ◽

Hearing Recovery ◽

Speech Performance

Introduction: Audiovestibular symptoms are rare in sarcoidosis, but they may also be the first manifestation of the disease. Sudden or progressive bilateral hearing loss is usually associated with vestibular impairment. The mechanism of hearing loss remains unclear, but clinical presentation and magnetic resonance imaging suggest a retrocochlear site for the lesion in most patients. Several cases of hearing recovery after corticosteroid treatment have been reported. In patients with severe or profound hearing loss, the benefit of cochlear implantation is challenging to predict in the case of auditory neuropathy and is rarely described. We present a case series of cochlear implantation in patients with documented neurosarcoidosis. Results: Seven cases of cochlear implantation in 4 patients with neurosarcoidosis are reported. All of the patients showed a great improvement very quickly in both quiet and noise. Speech performance remained stable over time with a follow-up ranging from 4 to 11 years, even in patients who had disease exacerbation. Conclusion: Cochlear implantation is possible in deaf patients with neurosarcoidosis. The excellent benefit obtained in our patients suggests a particular type of neuropathy, but endocochlear involvement cannot be entirely ruled out.

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Evaluation of Allergic Reactions Following Intravenous Infusion of Polyvalent Antivenom in Snakebite Patients

Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry ◽

10.2174/1871523020666210204143756 ◽

2021 ◽

Vol 20 ◽

Author(s):

Ghafar-Ali Mahmoudi ◽

Maryam Ahadi ◽

Ali Fouladvand ◽

Bareza Rezaei ◽

Zahra Bodagh ◽

...

Keyword(s):

Rural Areas ◽

Adverse Reactions ◽

Standard Treatment ◽

Clinical Presentation ◽

Demographic Data ◽

Maculopapular Rash ◽

Clinical Feature ◽

Allergic Reactions ◽

Related Data ◽

The Mean

Background: Antivenom is a gold-standard treatment for snakebite envenoming. However, adverse reactions to snake antivenom are common in many parts. Objective: The aim of this study was to evaluate the allergic reactions following intravenous administration of antivenom sera. Methods: This was retrospective study, conducted snakebites patients referred to the Rahimi Hospital in Khorramabad. The files of these patients were accessed for demographic data, snakebite-related data, treatment provided, clinical presentation and allergic reaction status as a result of antivenom treatment. Results: 141 cases were investigated including 73.8% male and 26.2% female patients. The mean age of the patients was 38.1±17.1years. Age group 30-39 years accounted for highest number of snakebite cases (24.1%). A majority of victims (89.4%) were from the rural areas. Most of the patients (51.8%) were bitten in the spring and highest number of snakebite were reported in May (39.1%). The most common site of snakebite was lower extremities (50.4%) and upper extremities (44.7%). Among clinical feature of snakebite, pain was the most prevalent in 135 cases (95.7%) followed by swelling (83.7%). The mean antivenom vials used were 6.5±3.7 vials. Allergic reactions occurred in 6 patients (4.26%); reactions were mild in 5 patients and sever in 1patient. The commonest presentation was maculopapular rash (1.4%) and the least common were headache (0.71%), nausea (0.71%), fever (0.71) and hypotension (0.71%). Conclusion: Snakebite is one of the significantlife-threatening environmental events.Immediate antivenom treatment can reduce mortality however, patients should be carefully monitored for adverse allergic reactions.

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Comparison of Corticosteroid and Vincristine in Treating Kaposiform Hemangioendothelioma and Tufted Angioma: A Systematic Review and Meta-Analysis

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1673708 ◽

2018 ◽

Vol 29 (05) ◽

pp. 401-407 ◽

Cited By ~ 5

Author(s):

Wei Yao ◽

Kai Li ◽

Zuopeng Wang ◽

Jiahao Pei ◽

Xiangqi Liu ◽

...

Keyword(s):

Recurrence Rate ◽

Adverse Reactions ◽

Meta Analysis ◽

Case Series ◽

Research Quality ◽

Cochrane Library ◽

Kaposiform Hemangioendothelioma ◽

Systemic Corticosteroids ◽

Tufted Angioma

Objective To evaluate the outcome and safety of corticosteroids and vincristine (VCR) in the treatment of kaposiform hemangioendothelioma (KHE) and tufted angioma (TA). Materials and Methods Clinical studies involving corticosteroids and VCR therapies in treating KHE/TA were identified by using PubMed, Cochrane Library, OVID, EBSCO, CNKI, VIP, and Wanfang databases from their establishment date to December 2017. Randomized controlled trials, case–control, or case series with more than five cases were included. The following data were extracted: study sample, demographics, responses rate, recurrence rate, and adverse reactions. Two reviewers completed screening and extraction. Methodological quality was evaluated with quality appraisal tool. Results A total of 266 studies were found, and 27 studies were finally included in this research; quality of all studies was low. Seven studies with a total of 123 participants, which compared the effect of systemic corticosteroids with that of VCR, were performed for the meta-analysis. The results indicated that the effect of VCR was significantly higher than that of corticosteroids (relative risk [RR] = 2.08, 95% confidence interval [CI]: 1.38–3.16). The recurrence rate of VCR (11.1%) was lower than that of corticosteroids (50%), but there was no statistical difference between the two therapies (p = 0.1312). The result of pooled adverse reactions response rate for VCR was 18.2%, significantly lower than that for corticosteroids, which was 52.0%. Conclusion The present profile shows that VCR is relatively more effective and safer in treating KHE/TA than corticosteroids are. So, we believe VCR could be used as a first-line medication agent in the treatment of KHE/TA.

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Papulopustular rash following Moderna COVID-19 (mRNA-1273) vaccine: A case report

Journal of Skin and Sexually Transmitted Diseases ◽

10.25259/jsstd_85_2021 ◽

2022 ◽

Vol 0 ◽

pp. 1-5

Author(s):

David Pudukadan

Keyword(s):

Case Report ◽

Adverse Events ◽

Adverse Reactions ◽

Healthcare Professionals ◽

Systemic Steroids ◽

Effective Care ◽

Short Course ◽

The World

Coronavirus disease-2019 (COVID-19) has affected countries around the world. The introduction of COVID-19 vaccines has proved the most effective arsenal in the fight against the disease. However, with the vaccination of billions of people, data on vaccine-induced adverse reactions are also emerging. We report a 32-year-old woman who manifested papulopustular rash 7 days after receiving Moderna COVID-19 (mRNA-1273) vaccine. The patient responded to a short course of systemic steroids and antihistamines. Awareness regarding the possible adverse events that can be anticipated after the COVID-19 vaccination may help the healthcare professionals to offer prompt and effective care to the affected.

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Steroid-induced Rosacea- A Study From a Tertiary Care Hospital of Eastern Nepal

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v19i1.35952 ◽

2021 ◽

Vol 19 (1) ◽

pp. 25-29

Author(s):

Manoj Chaudhary ◽

Sudha Agrawal

Keyword(s):

Tertiary Care ◽

Age Groups ◽

Case Series ◽

Sun Exposure ◽

Care Hospital ◽

Facial Erythema ◽

Case Series Study ◽

The Face ◽

Triggering Factor ◽

Study Population

Introduction: Topical corticosteroids (TC) are useful for treatment of various dermatological conditions in all age groups. Due to its cosmetic application TCs misuse is intertwined with fairness creams in our colour conscious society where people are obsessed with fair colour. Aims and Objectives: To find the clinical presentations of steroid induced rosacea like-dermatitis on the face and to evaluate the purpose behind misusing TCs on the face. Materials and methods: Descriptive prospective questionnaire-type case series study was approved by Institutional Ethical Committee of BPKIHS which involved 205 patients diagnosed as Steroid Induced Rosacea who consulted Dermatology OPD between March to June 2017. Results: Among 205 patients enrolled, majority were from second to fourth decade (87.31%) of their life and maximum being females I.e. 91.2%. Around 97% of the study population were unaware of side effects of TCs. Most patients use Mometasone fuorate (58.04%) for melisma (88.29%). Friends acted as source of prescription (29.75%), followed by Pharmacist (24.88%) & Beauty centers (20%). Dermatologists prescribed TCs in only 6.34% cases. Sun exposure was identified as the triggering factor for steroid induced rosacea in 73.17% patients. Cheek was the commonest site involve in 92.19%, followed by forehead (65.36%), perioral area (46.83%), and chin (9.75%). Mixed type of lesions was the commonest lesion found in 52.20% patients, followed by diffuse facial erythema (36.09%), & telangiectasia (33.17%). Conclusion: TCs misuse in the younger people for the sake of fairer skin with little or no knowledge about the adverse effects of this medication should be stopped.

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