Study Evaluates Cutaneous Reactions to COVID-19 mRNA Vaccines

Lacey Robinson, MD, MPH

A new research letter described the incidence and prevalence of cutaneous reactions to the mRNA COVID-19 vaccines.

A research team, led by Lacey Robinson, MD, MPH, prospectively studied employees at Mass General Brigham who received a dose of the Pfizer-BioNTech or Moderna vaccines.

First doses were administered between December 16, 2020 – January 20, 2021, and follow-up occurred through February 26, 2021.

Patients completed daily symptom surveys for 3 days post-administration — surveys were offered through emails, text messages, phones, and smartphone application links. The investigators then calculated number and frequency of self-reported cutaneous reactions; frequencies were compared using χ2 tests.

Findings

Overall, 25% of the 49,197 vaccinated employees received the Pfizer-BioNTech vaccine and 75% received the Moderna vaccine. As many as 83% of patients who received either vaccine completed at least 1 symptom survey.

“Cutaneous reactions were reported by 776 respondents after dose 1 (1.9%; 95% CI, 1.8%-2.1%), Robinson and colleagues indicated. “Rash and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 559 (1%; 95% CI, 1.8%-2.1%).”

Reactions were more common with the Moderna vaccine (2.1%; n = 626) than with the Pfizer vaccine (1.4%; n = 150), with higher frequencies of itching or rash, urticaria, and swelling observed for Moderna.

The mean age was 41 years old among those reporting cutaneous reactions. Additionally, females (85%) were significantly more likely to have reactions than men (15%; P<.001).

Reactions were also more common in White individuals (62%) compared with Asian (12%) and Black (7%) individual (P<.001).

Nevertheless, 95% of those who self-reported a reaction to the first dose ended up receiving their second dose.

The team noted that 83% of the 609 respondents to the second dose survey who experienced a first dose reaction did not report any recurrent cutaneous reactions. Further, 2.3% (n = 765) of individuals who did not initially experience a reaction reported a reaction following the second dose.

Similar to the first dose, rash and itching (other than the injection site) was the most common reaction (1.6% [n = 546]; 95% CI, 1.5-1.8).

“Unlike anaphylaxis, cutaneous reactions alone are not a contraindication to revaccination,” the investigators wrote. As such, there would be no need to refer patients to an allergist or dermatologist unless reactions are severe.

“These data are reassuring for the millions of Americans who may develop cutaneous reactions after vaccination in the coming year,” they concluded.

In an interview with HCPLive®, Esther Freeman, MD, PhD, of Massachusetts General Hospital, indicated that many of the dermatologic reactions to the vaccines are similar to the observed reactions to the SARS-CoV-2 virus.

Currently, she and colleagues are curating and evaluating the COVID-19 Dermatology Registry, a database developed in collaboration with the American Academy of Dermatology (AAD) and the International League of Dermatologic Societies (ILDS).

The growing registry includes information from patients on reactions to both COVID-19 and the vaccine, specifically noting adverse cutaneous reactions.

The research letter, “Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines,” was published online in JAMA Dermatology.