Cutaneous adverse effects of COVID-19 vaccines: what do we know so far?

Abstract

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection, also called COVID-19 (coronavirus disease 2019), has been the main public health issue for over a year. There are over 160 million people diagnosed with COVID-19. The authorization of first vaccines in the European Union is the key factor in the global response to the health crisis. In Romania, four vaccines are in use: Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), AstraZeneca-Oxford (Vaxzevria – ChAdOx1 nCoV-19) and Johnson and Johnson’s (Ad26.COV2.S). All four of them may cause adverse cutaneous reactions with different morphology. The most frequent are local adverse reactions, which do not require allergological assessment and do not contraindicate the administration of the second dose. Rarely, delayed cutaneous reactions such as “COVID arm” or dermal filler reactions have been reported and are accompanied by the need for elucidation of the pathophysiological mechanisms underlying them. There are also severe general reactions, but these are very rare. Allergological expertise is indispensable in the risk assessment of patients presenting with cutaneous reactions after the first dose of the vaccine. The allergist can also decide the need for skin testing to the vaccine. This approach could prevent patients from being deprived of the huge benefit of anti-COVID-19 immunization.