Kevin Sheng-Kai Ma, Chin-Hsuan Shen, Meng-Han Chiang, Kimberly G Blumenthal, Steven T Chen
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Abstract
Background: Increasing cases of vaccine-related severe cutaneous adverse reactions (SCARs) are reported in the literature.
Objectives: To provide comprehensive information regarding the clinical spectrum of vaccine-associated SCARs.
Methods: This was a systematic review and meta-analysis on case reports, case series, cohort studies, case-control studies, and post-market surveillance of SCARs following vaccination. Data on demographic information, classes of vaccination, past medical history and medications, and types, manifestations, management, and prognosis of SCARs, including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and generalized bullous fixed drug eruptions (GBFDE), were extracted.
Results: A total of 255 cases of SCARs following vaccination were identified. 231 (91%) of the reported cases of vaccine-associated SCARs were identified as SJS/TEN. The pooled incidence of SCARs following vaccination was 1.676 per million (95% confidence interval=0.136-20.668; I2 = 97%). The H1N1 vaccine (n=52), coronavirus disease 2019 (COVID-19) vaccines (n=38; 23 [61%] from mRNA vaccines), and influenza vaccine (n=33) contributed to most of these cases. AGEP and DRESS were frequently reported with COVID-19 vaccines, particularly the mRNA vaccines (57.1% [4/7] and 83.3% [5/6], respectively) and viral vector vaccines (28.6% [2/7] and 16.7% [1/6]). No SCAR was reported for protein-based COVID-19 vaccines. Six cases of fatal SJS/TEN were reported, with two cases associated with the COVID-19 vaccine.
Conclusions: SCARs following vaccination were extremely rare, with a high proportion of these cases SJS/TEN. Most suspected culprits included the H1N1 vaccine, the influenza vaccine, the varicella vaccines, and COVID-19 vaccines especially mRNA vaccines. However, concurrent medication use may confound underlying attribution of SCARs to vaccines.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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