Urticarial Rash Research Articles

Cutaneous manifestations of SARS-CoV-2 infection during the Delta and Omicron waves in 348 691 UK users of the UK ZOE COVID Study app.

BackgroundSymptoms of SARS‐CoV‐2 infection have differed during the different waves of the pandemic, but little is known about how cutaneous manifestations have changed.ObjectivesInvestigate the diagnostic value, frequency, and duration of cutaneous manifestations of SARS‐CoV‐2 infection and explore their variations between the Delta and Omicron waves of the pandemic.MethodsIn this retrospective study, we used self‐reported data from 348,691 UK users of the ZOE COVID Study app, matched 1:1 for age, sex, vaccination status, and self‐reported eczema diagnosis between the Delta and Omicron wave, to assess the diagnostic value, frequency, and duration of five cutaneous manifestations of SARS‐CoV‐2 infection (i.e., acral, burning, erythematopapular, and urticarial rash and unusual hair loss), and how these changed between waves. We also investigated whether vaccination had any effect on symptom frequency.ResultsWe show a significant association between any cutaneous manifestations and a positive SARS‐CoV‐2 test result, with a diagnostic value that was higher in the Delta compared to the Omicron wave (OR=2.29, 95% CI=2.22‐2.36, P<1.0x10‐300 and OR=1.29, 95% CI=1.26‐1.33, P=6.6x10‐64, respectively), when cutaneous manifestations were also more common (17.6% vs 11.4%, respectively) and had a longer duration. During both waves, cutaneous symptoms clustered with other frequent symptoms and only rarely (in less than 2% of the users) were the first or only clinical sign of SARS‐CoV‐2 infection. Finally, we observed that vaccinated and unvaccinated users showed similar odds of presenting a cutaneous manifestation, apart from burning rash, whose odds were lower in vaccinated users.ConclusionsCutaneous manifestations are predictive of SARS‐CoV‐2 infection, and their frequency and duration have changed with different variants. Therefore, we advocate for their inclusion in the list of clinically relevant COVID‐19 symptoms and suggest that their monitoring could help identify new variants.

Commercial visible-light protecting sunscreens for photosensitive individuals.

Visible light sensitivity can have a severe adverse impact on quality of life leading to withdrawal from social activity during daylight hours. Treatment options are limited and expensive. Commercially available sunscreens that provide visible light protection is of immediate practical importance, particularly for patients with Erythropoietic Protoporphyria (EPP) and Solar Urticaria as they experience intense symptoms of pain, burning, itch and urticarial rash or phototoxic erythema within seconds to minutes of even minor VL exposure.

Successful desensitization in a patient with adalimumab hypersensitivity

Adalimumab is a fully-humanized monoclonal antibody against tumor necrosis factor alpha (TNF-α) that is used to suppress the immune response. Though rare, hypersensitivity reactions to adalimumab can occur. Desensitization protocols have been developed to safely administer many medications in patients with Type I and Type IV hypersensitivity reactions. This case describes a teenage patient with Crohn's Disease who developed a delayed pruritic urticarial rash hypersensitivity reaction to adalimumab. A novel desensitization protocol was developed based on available literature. Our protocol consisted of four weekly doses, with the first dose in seven steps, second dose in two steps, and two full doses at weekly intervals, before spacing to biweekly injections. This multipart protocol was necessary due to the long half-life of adalimumab, which also allows for maintenance of the desensitized state in between injections. This protocol successfully treated our patient's hypersensitivity to adalimumab, with no further hypersensitivity occurring over a two-year follow-up period.

A RED HERRING? PAINFUL URTICARIA FOLLOWING AMPICILLIN CONTACT EXPOSURE

<h3>Introduction</h3> Acute painful urticaria is often caused by an underlying systemic illness or exposure to a drug or vaccine. Occasionally, no cause is found which prompts consideration of other etiologies. <h3>Case Description</h3> A 22-year-old male nurse with a history of Amoxicillin allergy (delayed-onset exanthematous rash) presented to the ED with an urticarial rash, 48 hours following an accidental ampicillin exposure to his right hand at work. Initial symptoms started 24 hours later with painful swelling of bilateral hands. Despite treatment with prednisone and diphenhydramine, a painful, pruritic urticarial rash developed on his arms, trunk, gluteal cleft, and knees. New onset arthralgias and angioedema prompted presentation to the ED, where he was treated for anaphylaxis and started on intravenous steroids and antihistamines. Initial labs showed a neutrophilic leukocytosis and a mild elevation in CRP. Workup revealed normal complement with negative infectious and rheumatologic evaluations. A punch biopsy showed "perivascular and interstitial neutrophilic infiltrate with few eosinophils," concerning for neutrophilic urticarial dermatosis (NUD) or a serum sickness like drug reaction (SSLR). Seven days after exposure, symptoms began to improve leading to discharge. <h3>Discussion</h3> NUD often occurs in the setting of an underlying systemic disease such as SLE or adult-onset Still's disease. Recently, SSLRs have also been identified as a cause of NUD. SSLRs are not well understood and have not previously been described as systemic contact reactions. Although, ampicillin exposure was thought to be a red herring in this case, further investigation is needed to better understand a potential relationship when another etiology cannot be identified.

A RARE CASE OF PROTRACTED ANAPHYLAXIS CAUSED BY ACETAMINOPHEN

<h3>Introduction</h3> Acetaminophen is a rare but recognized etiology of anaphylaxis. We present an unusual case of protracted anaphylaxis requiring intensive care unit (ICU) monitoring following intravenous (IV) acetaminophen. <h3>Case Description</h3> A 49-year-old female with a history of ovarian cancer presented to the emergency department with pruritic urticarial rash, fevers, tachycardia, and relative hypotension. A sepsis workup was initiated. Hemodynamics improved with broad-spectrum antibiotics and fluids. Due to symptomatic high-grade fevers, IV acetaminophen was administered. Her rash, tachycardia, and relative hypotension worsened one hour following infusion. Despite resuscitation with diphenhydramine and fluids, she remained tachycardic and febrile, prompting treatment for suspected anaphylaxis with intramuscular epinephrine, corticosteroids, and additional diphenhydramine. Her rash and hemodynamics improved moderately. She was subsequently started on norepinephrine and transferred to the medical ICU, where she had two days of persistent tachycardia and fluctuating urticarial rash responsive to antihistamines. Infectious workup was unrevealing. She later revealed a prior history of urticaria following home oral acetaminophen. Tryptase drawn one hour after decompensation was elevated to 23.8 mcg/L (baseline 3.2 mcg/L). The diagnosis was made of IgE-mediated reaction to acetaminophen causing protracted anaphylaxis. <h3>Discussion</h3> Anaphylaxis secondary to acetaminophen is an uncommon but recognized phenomenon. An initial differential included pseudoallergic reaction, given acetaminophen can be a weak cyclooxygenase-1 inhibitor causing direct mast cell activation and urticaria; however, this does not classically cause hypotension. Overall, this presentation may represent a mixed picture of sepsis of unclear etiology with superimposed IgE-mediated reaction. It is important to recognize anaphylaxis can co-exist with sepsis and manifest with overlapping symptoms.

004 Systemic autoinflammatory diseases: a multicenter cohort study

BackgroundSystemic autoinflammatory diseases (SAIDs) are a group of hereditary diseases characterized by inflammatory attacks accompanied by clinical findings such as fever, skin rash, abdominal pain, and musculoskeletal symptoms and with high acute phase response.ObjectivesThis study sought to define the characteristics, to report 24-month follow-up of children with SAIDs and to compare the performances of both the previously validated classification criteria Federici and new Eurofever/PRINTO classification criteria in a multicentre cohort under real-life conditions.MethodThe medical charts of 60 children diagnosed with SAIDs (CAPS, TRAPS and HIDS) who were followed up regularly every 1–3 months between 2010 and 2021 in 6 pediatric rheumatology centers in Turkey were retrospectively analyzed. Demographic data, clinical findings, laboratory results and treatments were recorded. All patients were analyzed by NGS panel containing 16 genes.ResultsA total of 60 patients with SAID were evaluated. Among them 30 (50%) were male and 30 (50%) were female. The median age at disease onset and diagnosis were 22 (0–193) months and 72 (2–213) months, respectively. The current age was median 10.3 (1.7–20.4) years. All patients were follow-up with a median 31 (6–97) months. Among 60 patients, 22 were diagnosed with CAPS, 8 with TRAPS and 30 with HIDS. The frequency of clinical symptoms was 95%, arthralgia 63.3%, gastrointestinal complaints 58.3%, urticarial rash 56.7%, myalgia 48.3%, lymphadenopathy 33.3%, respectively.Urticarial rash (86.4%), cold induced rash (45.5%) and arthritis (50%) were significantly higher in CAPS patients compared with other two groups (p< 0.05). Lymphadenopathy (46.7%) was more common in HIDS patients (p = 0.03).When we applied the diagnostic/classification criteria to our cohort, 71.7% met the Federici criteria, 53.3% fulfilled the Eurofever/PRINTO classification criteria. When performance of two diagnostic criteria (Federici and Eurofever/PRINTO criteria) was compared, the proportion of patients fulfilling the Eurofever/PRINTO criteria higher in TRAPS patients compared with other groups (p = 0.008).Statistically significant decreases were found in AIDAI scores, CRP, ESR levels from the 1st month and in the leucocyte counts from the 6th month of the treatment in CAPS patients (p = <0.001, p = 0.035, p = 0.03 and p = 0.006, respectively). In addition, AIDAI scores were correlated with CRP values (p = 0.047).In HIDS patients, there was a statistically significant decrease in AIDAI scores and ESR levels from the 1st month, CRP levels from the 3rd month, and leucocyte counts from the 12th month of treatment (p = <0.001, p = 0.003, p = <0.001 and p = 0.034, respectively). In addition, ESR values were correlated with CRP (p = 0.006). In TRAPS patients, on the other hand, there was a statistically significant decrease in AIDAI scores from the 1st month of treatment (p = 0.018).At the last visit, 93.3% of the patients were receiving anti-IL-1, 5% anti-IL-6, and 1.7% were receiving colchicine. Ninety percent of the patients were in complete remission.ConclusionWe showed that the diagnostic/classification criteria may not always be sufficient to make the diagnosis, and there is still low agreement between clinical diagnoses and molecular analyzes. Anti-IL-1 treatments have been found to be quite effective in the treatment from the early period.

Fever and acute urticaria in a young male patient

A 23-year-old man presented to our emergency department with a new onset of low-grade fever associated with diffuse itching urticarial rash localized to his trunk and upper limbs. He denied respiratory and gastrointestinal symptoms. Peripheral oxygen saturation was 98% at room ambient. His past medical history was unremarkable, and he was not taking any medications. No history of allergies was reported. He denied traveling abroad, contact with animals, ingesting raw meat or fish, or taking medicine. Laboratory results showed leukopenia with lymphocytopenia and normal C-reactive protein value. Eosinophils were normal. Hepatic and renal tests were all within the normal range. He was vaccinated with 3 doses of Comirnaty vaccine with no adverse reactions. Lung ultrasound showed A pattern without pleural effusion. The patient was discharged with oral steroids (prednisone 25 mg for three days with a progressive reduction in 10 days) and oral antihistamine (bilastine 10 mg daily for 10 days), and acetaminophen 1 gr if fever above 37.5°C, with complete resolution of the rash without sequelae in 10 days.

Henoch-Schönlein purpura following COVID-19 vaccine in a child: a case report

BackgroundHenoch-Schönlein purpura (HSP) is an IgA-mediated small vessel vasculitis, typical of childhood. It’s a self-limiting disease and it affects different systems. HSP is characterized by dermatological, abdominal, joint and renal clinical manifestations. This condition usually occurs upon infections, mainly upper respiratory tract ones, medications, vaccinations and malignancies.Case presentationWe describe the case of a 11 year-old girl who developed a urticarial rash 12 days after the first dose of Pfizer-BioNTech BNT16B2b2 mRNA vaccine and a clear picture of Henoch Schönlein purpura 5 days after administration of the second dose of the same vaccine.ConclusionTo our knowledge, this is the first description of a pediatric patient with Henoch-Schönlein purpura occurring in association with vaccination against COVID-19.

Skin Manifestations of COVID-19

Coronavirus-19 (COVID-19) is an ongoing global pandemic, which was isolated for the first time in Wuhan (China), in December 2019. Although this virus is most well known for causing respiratory pathologies, in medical practice, there are being reported more cases with heterogenous cutaneous presentations. These lesions manifest at various times in relation to COVID-19 symptoms, which may indicate whether the lesions are virus-induced or are delayed immunological responses to the infection. The main purpose of this study is to evaluate the distribution, types, and highest skin manifestations of Covid-19. Finding the potential link between Covid-19 and cutaneous manifestations may help to understand the pathogenesis and best policies in disease control. The pathophysiology of these lesions remains under study and still unclear. To achieve this goal, a transversal study was conducted on the population, the period March 1, 2021, to July 16, 2021. Out of 205 suspected / laboratory-confirmed people, there were 13 people with cutaneous signs, of which 13 were female and 9 were male. The most common morphological form was morbilliform rash, chicken-pox-like vesicles, and urticarial rash.

Cutaneous manifestations Of COVID-19

The coronavirus 2019(COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), has had enormous health, economic, and social consequences. Cutaneous manifestations associated with COVID-19 probably reflect the activation of pathogenic pathways by the virus or a response to inflammatory processes, vascular or systemic complications, or even treatments. There is no previous detailed classification or description of the cutaneous manifestations of COVID‐19. This information may prove useful to manage patients and to recognize paucisymptomatic patients and might provide prognostic information. The recognition of paucisymptomatic patients could also be helpful for epidemiological control, especially in areas where diagnostic tests are scarce. This is a cross-sectional study among the COVID positive patients admitted in Index Medical College Hospital and Research Centre (Tertiary Care Centre) Indore from 1st May 2020 – 30th November 2020. Considered initially as of little relevance, the dermatological manifestations observed in patients with COVID-19 are both heterogeneous and complex. 5 main categories of lesions identified; vesicular rashes, urticarial rashes, acral lesions, maculopapular rashes and livedoid &amp; necrotic lesions.

Cutaneous manifestations of Coronavirus Disease 2019.

BackgroundCOVID‐19 has been linked to a variety of dermatological conditions.ObjectiveTo determine the presence of various cutaneous manifestations in patients with COVID‐19, also to define their features in relation to the systemic symptoms.MethodsThis research enrolled a total of 1206 lab‐confirmed COVID‐19 individuals at a tertiary care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID‐related skin conditions. COVID‐19 severity was categorized as asymptomatic/mild, moderate, or severe.ResultsOf the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculo‐papular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer‐lasting vascular pattern was related with an older age and a fatal COVID‐19 outcomes (P: 0.000) compared to mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared to moderate/severe infection.LimitationsSingle‐Centre and observational study.ConclusionVascular lesions were correlated with disastrous COVID‐19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, whilst the urticarial rash was linked to milder course compared to moderate/severe severity infection.

Urticarial Rash in a Patient with Alpha-Gal Syndrome Caused by Subcutaneous Heparin at Prophylactic Dosing: A Case Report

Introduction: We report a patient with a history of red meat allergy, or alpha-gal syndrome, who had an urticarial rash after exposure to unfractionated heparin at a dose typically used for prophylaxis of deep venous thrombosis. Although anaphylactic reactions have been reported with systemic intravenous heparin, we believe this case is the first report of an immunoglobulin E–mediated reaction to subcutaneous heparin at prophylactic dosing. Clinical Findings: An 85-year-old male had a 3-year history of red meat allergy and was intolerant of pork and beef. He developed an immunoglobulin E–mediated allergic reaction to subcutaneous heparin at a dose of 5000 units twice daily. Clinical Course: The patient presented to the emergency department after a fall. He had back pain and was diagnosed with a compression fracture. He was admitted to the hospital because he was unable to safely ambulate. He was treated with subcutaneous unfractionated heparin to prevent deep venous thrombosis as part of routine care. Twenty-four hours after exposure to heparin, he developed an urticarial rash. The rash resolved promptly after discontinuing heparin and excluding other potential allergic triggers. Conclusions: In patients with alpha-gal syndrome, unfractionated heparin via a subcutaneous route at prophylactic dosing can precipitate immunoglobulin E–mediated systemic reactions and should be avoided.

Development and Evaluation of Antimicrobial Activity of Durva Nishadi Ointment: In-vitro Study

Background: Synthetic antimicrobials are often associated with adverse effects as a result, there is need for the use of alternate herbal medicines is increasing with their easy availability, safety, cost effectiveness and therapeutic potentiality. In this present study Durva Nishadi Ointment was developed from Durva nishadi Yoga described in Ayurvedic classics as a Lepa (topical application) against microbial diseases like Kandu (Pruritis), Pama (Scabies), Dadru (Tinea/ Ringworm infection), Sheetapitta (Urticarial rashes) and Krimi (Microbial infections).&#x0D; Result: The developed Durva Nishadi ointment has highly significant antifungal activity than the antibacterial activity. Antifungal activity of 20% ointment against Candida albicans was 28mm of zone of inhibition at 25 μg/ ml, and for Aspergillus niger 15 mm of zone of inhibition at 5 μg/ ml, which are highly comparable with the synthetic standard drug used for the antifungal activity i.e. Fluconazole.&#x0D; &#x0D; Abbreviations&#x0D; MIC - Minimum inhibitory concentration, MHA - Muller-Hinton Agar&#x0D;

Autoinflammatory disease syndrome of hyperimmunoglobulinemia D

Objective: present a clinical case of a rare autoinflammatory disease. Materials and methods: an analysis of a clinical case of mevalonate kinase deficiency syndrome in an 8-year-old girl was carried out. Results: mevalonate kinase deficiency syndrome (SDMC) is a rare autoinflammatory disease with an autosomal recessive inheritance mechanism. The severity of the disease correlates with the residual activity of the enzyme mevalonate kinase, which is involved in the biosynthesis of cholesterol and isoprenoids, which is necessary for the conversion of mevalonate into the final product. As a result, the body accumulates mevalonic acid, especially high levels of it are found in the urine. A relatively mild SDMC phenotype is distinguished: hyperimmunoglobulinemia syndrome D (first described as HIDS in 1984) and a severe variant – mevalonic aciduria. A little more than 300 patients with SDMC have been described in the world. The disease is manifested by intermittent fever, arthralgia, pharyngitis, cervical lymphadenitis, urticarial rash resembling urticaria, less often vasculitis-like manifestations in the form of petechial-purple elements. Diagnosis is based on the activity of the mevalonate kinase enzyme in the blood or skin cells, biochemical analysis of urine (high numbers of mevalonic acid), as well as genetic confirmation of a mutation in the mevalonate kinase gene. The main principles of therapy for autoinflammatory diseases are the control of clinical symptoms and inflammation in general, as well as the prevention of amyloidosis. Conclusion: if an autoinflammatory process in the body is suspected, it is necessary to conduct a genetic study for timely diagnosis and the appointment of pathogenetic therapy to improve the quality of life and prevent complications.

COVID-19 and cutaneous manifestations: Two cases and a review of the literature

COVID-19 can affect multiple organs, including skin. A wide range of skin manifestations have been reported in literature. Six main phenotypes have been identified: i) urticarial rash, ii) confluent erythematous/maculopapular/morbilliform rash, iii) papulovesicular exanthem, iv) a chilblain-like acral pattern, v) a livedo reticularis/racemosa-like pattern, and vi) a purpuric vasculitic pattern. The pathogenetic mechanism is still not completely clear, but a role of hyperactive immune response, complement activation and microvascular injury have been postulated. The only correlation between the cutaneous phenotype and the severity of COVID-19 has been observed in the case of chilblain-like acral lesions, that is generally associated with the benign/subclinical course of COVID-19. Herein, we report two cases of SARS-CoV- 2 infection in patients who developed cutaneous manifestations that completely solved with systemic steroids and antihistamines. The first case is a female patient not vaccinated for SARS-CoV-2 with COVID-19 associated pneumonia, while the second case is a vaccinated female patient with only skin manifestations.

Skin necrosis in COVID-19 patients: complication of therapy or one of clinical and pathological mechanisms of viral infection?

&lt;p&gt;The coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV). Dermatological disorders are among the numerous observations in COVID-19 patients that are consistently reported from various clinical sites throughout the world, although their relationship with illness severity is unknown. Urticarial rash, maculopapular or morbilliform rash, papulovesicular lesions, chilblain, livedo reticularis, vasculitis-like picture, and skin necrosis have all been reported with different frequencies and associated circumstances. In this review article, we will highlight reports of skin necrosis, one of the rare skin findings that are associated with COVID, and their clinical and pathophysiological aspects, in addition to attempting to determine whether they are one of the possible outcomes of this virus infection or a complication of various treatment programs. and to discuss the overlap between skin necrosis due to COVID-19-associated coagulopathies and disseminated intravascular coagulation. Cutaneous necrosis in COVID-19 patients during the pandemic period, according to this review, is not rare. possibly It is simple to diagnose and recognize this dermatological condition, but determining the causal variables and their function in pathogenesis is a complex and difficult task. It's also tough to categorize because it affects people of all ages, regardless of gender, ethnicity, or health status. All hypotheses discuss the direct viral role, the immune system's hyperinflammatory state with cytokine storm, the hypercoagulable state with vasculitis, anticoagulant therapy complications, and deep secondary necrotizing infections as possible interactions that lead to necrosis, which can result in serious outcomes such as disseminated intravascular coagulation if not properly treated.&lt;/p&gt;

Cutaneous manifestations of covid-19 in pediatric population: A web based comparative study between the perspectives of dermatologists and pediatricians

Objectives: To compare the perspectives of dermatologists and pediatricians regarding cutaneous manifestations of covid-19 in the pediatric age group. Material and methods: An online semi-structured English questionnaire was circulated among the doctors (snowball sampling). Items of the questionnaire with a content validity ratio ≥0.49 were retained. Content validity index (CVI) was estimated, and those with a CVI score of &gt;0.79, were accepted. Appropriate statistical tests were carried out for data analysis. Results: Among 305 responders, majority were dermatologists (n = 139; 45.57%) followed by pediatricians (n = 106; 34.75%) and other specialties (n = 60; 19.6%). Nearly 46.55% of all responders (n = 142) observed cutaneous manifestations among pediatric covid patients (40/139 dermatologists, 28.77%, and 94/106 pediatricians, 88.67%). Nearly 54.22% of pediatricians and 10% of dermatologists reported the infection to be moderate to severe. About 15% of dermatologists and 5.3% of pediatricians came across cutaneous manifestations as the sole manifestation. The commonest manifestation was urticarial (61.26%) followed by a morbilliform rash (52.81%). Multisystem inflammatory syndrome in covid (MISC) was observed almost exclusively by 63.82% of pediatricians. Vascular manifestations were seen by 11.97% responders (n = 17). Chilblains were reported by 4.5% of pediatricians. Nearly 78.04% of pediatricians and 35% of dermatologists observed mucosal manifestations. Conclusion: Pediatricians are more commonly observing cutaneous manifestations. MISC is exclusively reported by pediatricians, highlighting the fact that severe disease is usually not seen by dermatologists. Vascular manifestations are uncommon in the skin of color. Dermatologists encounter asymptomatic covid patients with cutaneous manifestation more often, reiterating the fact that children presenting with urticarial and morbilliform rashes should be tested for covid-19, considering the present scenario.

Helminth Infections in Children.

Helminth Infections in Children.

Experience of long-term use of anti-IgE therapy in a patient with chronic spontaneous urticarial

Chronic spontaneous urticaria is an urgent health problem. Recurrent urticarial rashes, angioedema and severe itching reduce the quality of life of patients. The ineffectiveness of standard therapy requires the search for new modern methods of treating this disease. Taking into account the current data on the pathogenesis, the third line of therapy for chronic spontaneous urticaria is the addition of anti-IgE therapy (omalizumab) to antihistamines of the 2nd generation. The presented clinical case is devoted to the experience of long-term use of omalizumab in a patient with chronic spontaneous urticaria. Having a disease duration of about a year, the patient was thoroughly examined, all concomitant diseases were identified and compensated, parasitic invasion was treated, but this did not lead to a regression of symptoms. Antihistamines of the 2nd generation in standard and increased doses (up to 4 times) did not control the disease, systemic glucocorticosteroids stopped the symptoms for a short time, and therefore, in the future, the patient began to use them independently and uncontrollably. Almost daily use of corticosteroids for 6 months caused the development of complications in the form of weight gain and Cushing’s syndrome. Omalizumab completely stopped all the symptoms during the first day, no side effects were detected. The clinical effect lasted from 3 to 4 weeks. Thus, omalizumab therapy allowed the patient to almost completely get rid of the symptoms of CSC, which significantly improved the quality of life and made it possible to cancel systemic glucocorticosteroids. The peculiarity of the presented case is the duration of the use of omalizumab (more than 2 years) with the inability to cancel due to the return of urticarial rashes and itching.

P237 New-onset systemic lupus erythematosus following COVID-19 vaccination: a report of two cases

Abstract Background/Aims There is a growing number of reports of new-onset autoimmune disease or complications of underlying autoimmune disorders following COVID-19 infection and vaccination. Methods We describe two cases of systemic lupus erythematosus (SLE) that developed de novo in two female patients shortly after receiving their COVID-19 vaccinations. Results The first case is a 29-year-old female with no prior medical history. One week following her COVID-19 Pfizer/BioNTech vaccination, she developed widespread pruritus, fatigue, myalgia, arthralgia, fever and night sweats. Blood tests showed pancytopenia and she was referred for an urgent haematology opinion due to lymphoma. Positron Emission Tomography/computed tomography (PET/CT) demonstrated widespread lymphadenopathy. Bone and lymph node biopsy showed reactive changes only. Her symptoms progressed with polyarticular inflammatory arthritis, oral ulceration, Raynaud’s, pleuritic chest pain, palmar purpuric rash, and a widespread tender urticarial rash. Further investigations showed low complement C3/C4, anti-double stranded DNA antibody titre (dsDNA) &amp;gt;200 IU/mL, positive Anti-Ro antibody, positive Anti-La antibody, weakly positive anti-RNP antibody and an Anti-C1q antibody &amp;gt;400 units/ml with a urine protein/creatinine ratio (PCR) of 39 mg/mmol. A diagnosis of SLE with urticarial vasculitis was made and she commenced Hydroxychloroquine in addition to weaning prednisolone (60mg). A skin biopsy confirmed lupus vasculitis. Despite high dose prednisolone, urine PCR increased over 2 weeks from 39 to 84 mg/mmol. Renal biopsy demonstrated class 3 lupus nephritis. She was pulsed with 500mg IV methyl prednisolone over 3 days and commenced mycophenolate 1g BD. Within weeks she was in clinical remission. The second case is a 70-year-old female with a past medical history of diverticulosis, uterine fibroids and small hand joint osteoarthritis. She presented with a sudden onset, 6-week history of bilateral symmetrical small and large joint synovitis that developed 8 days following the first dose of the COVID-19 Oxford-AstraZeneca vaccine. Her investigations showed reduced lymphocyte counts (0.9 109/L), raised CRP 26 mg/L and ESR 32 mm/hr. Antinuclear antibodies were weakly positive with a homogenous pattern. DsDNA titre was raised at 175 IU/mL and C4 reduced at 0.14 g/L. There was no proteinuria or any evidence of major internal organ involvement. She was started on a short reducing course of oral prednisolone given the severity of her presenting clinical features. Her symptoms improved, with no recurrence on stopping steroids but she has continued elevation in DsDNA; a conservative management approach is being adopted. Conclusion Both cases met the EULAR/ACR and SLICC classification criteria for SLE. There was a clear temporal association between the onset of SLE symptoms and COVID-19 vaccination. Our cases raise the possible association/causation of SLE following COVID-19 vaccination. Potential mechanisms include immune responses elicited by the COVID-19 vaccination, triggering autoimmunity in genetically predisposed individuals. Further research and data from registries are required. Disclosure J. Beynon: None. M. Alsharkawy: None. L. Sammut: None. J. Ledingham: None.