{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T08:16:50Z","timestamp":1781597810185,"version":"3.54.5"},"reference-count":15,"publisher":"Oceanside Publications Inc.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["allergy asthma proc"],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold>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.<jats:bold>Objective:<\/jats:bold>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.<jats:bold>Methods:<\/jats:bold>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.<jats:bold>Results:<\/jats:bold>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.<jats:bold>Conclusion:<\/jats:bold>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.<\/jats:p>","DOI":"10.2500\/aap.2022.43.210101","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T12:03:14Z","timestamp":1641384194000},"page":"40-43","source":"Crossref","is-referenced-by-count":31,"title":["Delayed systemic urticarial reactions following mRNA COVID-19 vaccination"],"prefix":"10.2500","volume":"43","author":[{"given":"Mitchell M.","family":"Pitlick","sequence":"first","affiliation":[{"name":"From the Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avni Y.","family":"Joshi","sequence":"additional","affiliation":[{"name":"From the Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexei","family":"Gonzalez-Estrada","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio E.","family":"Chiarella","sequence":"additional","affiliation":[{"name":"From the Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1355","reference":[{"key":"B1","article-title":"Interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States\u2014Appendix B"},{"key":"B2","doi-asserted-by":"crossref","first-page":"100517","DOI":"10.1016\/j.waojou.2021.100517","article-title":"COVID-19 vaccine-associated anaphylaxis: a statement of the World Allergy Organization Anaphylaxis Committee","volume":"14","author":"Turner","year":"2021","journal-title":"World Allergy Organ J"},{"key":"B3","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine","volume":"384","author":"Baden","year":"2021","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1111\/all.14711","article-title":"Allergic reactions to the first COVID-19 vaccine: a potential role of polyethylene glycol?","volume":"76","author":"Cabanillas","year":"2021","journal-title":"Allergy"},{"key":"B6","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1016\/j.jaci.2021.04.002","article-title":"Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines","volume":"147","author":"Risma","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"B7","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.anai.2021.03.012","article-title":"Polyethylene glycol and polysorbate skin testing in the evaluation of coronavirus disease 2019 vaccine reactions: early report","volume":"126","author":"Pitlick","year":"2021","journal-title":"Ann Allergy Asthma Immunol"},{"key":"B8","doi-asserted-by":"crossref","first-page":"3308","DOI":"10.1016\/j.jaip.2021.06.010","article-title":"First-dose mRNA COVID-19 vaccine allergic reactions: limited role for excipient skin testing","volume":"9","author":"Wolfson","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B9","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2500\/aap.2021.42.210069","article-title":"Allergic reactions and adverse events associated with administration of mRNA-based vaccines. A health-care system experience","volume":"42","author":"Arroliga","year":"2021","journal-title":"Allergy Asthma Proc"},{"key":"B10","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.jaip.2020.12.047","article-title":"mRNA vaccines to prevent COVID-19 disease and reported allergic reactions: current evidence and suggested approach","volume":"9","author":"Banerji","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B11","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1056\/NEJMc2102131","article-title":"Delayed large local reactions to mRNA-1273 vaccine against SARS-CoV-2","volume":"384","author":"Blumenthal","year":"2021","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1001\/jamadermatol.2021.1214","article-title":"Delayed localized hypersensitivity reactions to the Moderna COVID-19 vaccine: a case series","volume":"157","author":"Johnston","year":"2021","journal-title":"JAMA Dermatol"},{"key":"B13","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jaad.2021.03.092","article-title":"Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases","volume":"85","author":"McMahon","year":"2021","journal-title":"J Am Acad Dermatol"},{"key":"B14","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.det.2021.05.016","article-title":"COVID-19 vaccines and the skin: the landscape of cutaneous adverse reactions worldwide","volume":"39","author":"Sun","year":"2021","journal-title":"Dermatol Clin"},{"key":"B15","doi-asserted-by":"crossref","first-page":"e15153","DOI":"10.1111\/dth.15153","article-title":"Cutaneous adverse reactions after COVID-19 vaccines in a cohort of 2740 Italian subjects: an observational study","author":"Grieco","year":"2021","journal-title":"Dermatol Ther"}],"container-title":["Allergy and Asthma Proceedings"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/ocean\/aap\/2022\/00000043\/00000001\/art00010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,15]],"date-time":"2024-09-15T18:51:53Z","timestamp":1726426313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.2500\/aap.2022.43.210101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,1]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1,1]]}},"alternative-id":["1088-5412(20220101)43:1L.40;1-"],"URL":"https:\/\/doi.org\/10.2500\/aap.2022.43.210101","relation":{},"ISSN":["1088-5412"],"issn-type":[{"value":"1088-5412","type":"print"}],"subject":[],"published":{"date-parts":[[2022,1,1]]}}}