新冠mRNA疫苗接种后慢性荨麻疹随时间变化的特征

Features of chronic urticaria after COVID-19 mRNA vaccine over time.

作者信息

Schwab Johan, Foglierini Mathilde, Pescosolido Eva, Pacheco Ines, Ruiz Buendía Gustavo A, Madelon Natacha, Pellaton Celine, Banderet Véronique, Ribi Camillo, Bergmann Marcel M, Didierlaurent Arnaud M, Fenwick Craig, Duperrex Olivier, Muller Yannick D

机构信息

Division of Immunology and Allergy, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.

Biomedical Data Science Centre (BDSC) Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.

出版信息

Commun Med (Lond). 2024 Nov 30;4(1):254. doi: 10.1038/s43856-024-00656-y.

DOI:10.1038/s43856-024-00656-y

PMID:39616213

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11608360/

Abstract

BACKGROUND

New onsets of chronic urticaria (CU) have been reported after repeated immunizations, mainly with the Moderna mRNA-1273 vaccine (Spikevax). This study aims to evaluate patients with CU after COVID-19 mRNA vaccination. The contribution of SARS-Cov2 infection, atopy and IgE against the vaccine was analyzed.

METHODS

We monitored the features of patients who developed CU after vaccination through two surveys conducted in 2022 and 2023. Fifty individuals with CU underwent blood tests, and their results were compared with individuals without a history of urticaria (N = 135). The presence of anti-vaccine IgE was tested in 185 individuals with basophil activation tests (BAT). We assessed anti-SARS-Cov2 humoral response, and the presence of IgEs against common respiratory allergens (Phadiatop) as a surrogate for atopy.

RESULTS

Post-vaccination CU occurs after a median interval of 10 days and significantly more after the Spikevax booster, affecting middle-aged individuals (median 41, 66% females). In 2023, CU was still active in 53% of the cases. Inducible forms of CU, primarily dermographism, are reported in 54% (2022) and 61% (2023) of the cases. BAT positivity is not specific to CU, anti-nucleocapsid positivity, or atopy but is significantly associated with higher anti-spike neutralizing activities and younger age. Four CU patients tolerate an additional dose of mRNA vaccine with no disease exacerbation/recurrence.

CONCLUSIONS

The spikevax booster induces anti-vaccine IgE independently of CU, the latter being not directly associated with COVID-19 infection nor atopy. The tolerance to a new booster in 4/4 patients suggests that the Spikevax vaccine indirectly triggers CU in predisposed individuals.

摘要

背景

据报道，反复接种疫苗后会出现慢性荨麻疹（CU）新发病例，主要是接种Moderna mRNA-1273疫苗（Spikevax）后。本研究旨在评估接种新冠病毒mRNA疫苗后出现CU的患者。分析了严重急性呼吸综合征冠状病毒2（SARS-CoV2）感染、特应性和针对该疫苗的免疫球蛋白E（IgE）的作用。

方法

我们通过2022年和2023年进行的两项调查，监测了接种疫苗后出现CU的患者的特征。50例CU患者接受了血液检查，并将其结果与无荨麻疹病史的个体（N = 135）进行比较。通过嗜碱性粒细胞活化试验（BAT）对185例个体检测了抗疫苗IgE的存在情况。我们评估了抗SARS-CoV2体液反应，以及针对常见呼吸道变应原的IgE的存在情况（Phadiatop）作为特应性的替代指标。

结果

接种疫苗后出现CU的中位间隔时间为10天，在接种Spikevax加强针后更为常见，影响中年个体（中位年龄41岁，66%为女性）。2023年，53%的病例中CU仍处于活动状态。在54%（2022年）和61%（2023年）的病例中报告了可诱导形式的CU，主要是皮肤划痕症。BAT阳性并非CU、抗核衣壳阳性或特应性所特有，但与较高的抗刺突中和活性和较年轻的年龄显著相关。4例CU患者耐受额外一剂mRNA疫苗，疾病未加重/复发。