Cutaneous reactions after 1st COVID-19 vaccine dose not a reason to forgo 2nd dose

Skin reactions to the first COVID-19 vaccine in some individuals shouldn’t be a reason to leave out the second dose, or a scheduled booster if tolerable, according to an analysis presented at AAD 2022.

“Despite concerns, there are no serious adverse consequences from these cutaneous reactions,” said Dr Esther Freeman, director of Global Health Dermatology, Massachusetts General Hospital in Boston, Massachusetts, US.

This, she added, is crucial as the rate of vaccine hesitancy for the second dose has gone almost fourfold among individuals with cutaneous reactions and more than fourfold in those who developed angioedema or swelling underneath the skin, according to a follow-up of 52,000 employees vaccinated in the Mass General Brigham Healthcare System (MGBHS).

Of those vaccinated, 0.9 percent had a history of severe allergic reaction to a prior vaccine whereas 11.6 percent had an allergic reaction to the COVID-19 vaccine. Serious consequences were rare in both groups. Of those with a reaction to the first dose, all but 2.4 percent took a subsequent dose. Again, serious reactions were exceedingly rare.

‘We were concerned’

Injection-site reactions were expected for any vaccine, but a small proportion of patients developed red plaques in the affected arm a week after receiving the first jab, raising concerns among dermatologists. “We were concerned this might be cellulitis. Would the second vaccine dose cause anaphylaxis?” Freeman asked.

However, a global registry that dermatologists collaborated to track the dermatological manifestations of COVID-19 has shown that only about 2 percent of patients had cutaneous reactions after the first dose. The registry captured over 1,000 cutaneous reactions from 52 participating countries, but all resolved with skincare or no treatment at all.

The proportion of cases was lower after the second dose. Reactions, if there were, occurred earlier, were minor, and resolved with little or no supportive care.

No serious sequelae

“Fewer than half of patients who had a reaction to the first dose have a reaction to the second, and those who did have a reaction had a milder course,” Freeman shared. This she found as reassuring.

“The skin reaction is something we can treat,” she told fellow dermatologists, adding that patients should be counselled there are no serious sequelae from the rashes and that COVID-19 vaccination is something not tomiss out.

However,  Dr Kimberly G. Blumenthal, co-director of the Clinical Epidemiology Program at MGBHS, said the absence of serious sequelae from a COVID-19 vaccination must be weighed within the context of the benefit, which includes protection from death and hospitalization from the virus. However, it is important to educate the patients about relative risks.

Anaphylaxis, a severe, potentially life-threatening allergic reaction, can occur post-vaccination with any vaccine in certain susceptible individuals, but the risk is very low, Freeman added.

The US Centers for Disease Control and Prevention has issued interim considerations for preparing for the potential management of anaphylaxis whenever it occurs. In addition to screening for contraindications and precautions before administering COVID-19 vaccines, vaccine locations should have the necessary supplies available to manage anaphylaxis.