Anaphylactic Reaction Following Receipt of COVID-19 Vaccines:
Report of Two Cases
To the Editor,
Though rare, anaphylactic reactions may occur after vaccine injection.
Therefore, it is necessary to equip every vaccination location with
trained healthcare personnel and resuscitative equipment to manage
probable anaphylaxis. Since there is limited knowledge on adverse
reactions of novel COVID-19 vaccine, here we report two cases of
anaphylactic reaction after injection of Sputnik-V and
Oxford-AstraZeneca COVID-19 vaccines (Detailed presentation onSupplementary File ). In
A 54-year-old woman was referred to receive the second dose of Sputnik-V
vaccine. She denied a history of allergy, angioedema, and anaphylactic
reactions, and no severe reactions to childhood vaccines occurred.
Immediately after vaccination, a significant injection site bleeding was
started. One minute after injection, the patient suddenly developed
dizziness, facial angioedema, flushing, severe compressive chest pain,
dyspnea, and fear of death. Due to the patient’s signs and symptoms, and
intravenous (IV) fluid therapy and 100 mg hydrocortisone were initiated.
The patient’s condition improved in hours, and the symptoms were
relieved within two days. However, after 3 weeks, she is suffering from
the new onset nasal rhinorrhea and itching.
A 25-year-old man was referred to receive the first dose of AstraZeneca
vaccine. He had no history of underlying medical disorders and
hypersensitivity reactions. Childhood vaccination was done without any
adverse reaction. He underwent the intramuscular (IM) injection of
AstraZeneca vaccine. Almost seven hours after vaccination, the patient
gradually developed progressive cyanosis and swelling of all fingers of
both hands, fever, chills, fatigue, headache, and shortness of breath.
Gradually, the patient’s clinical condition deteriorated. His elbows and
legs became cyanotic, and he developed coldness and numbness of the
upper limbs (Figure 1) . Due to the patient’s symptoms and
signs, anaphylactic shock was considered, and treatment with normal
saline and 100 mg hydrocortisone was started. Gradually, the patient’s
cyanosis resolved, and he was discharged.
Anaphylactic shocks are rare, but life-threatening events may occur
after receiving vaccines. Individuals may develop anaphylactic reactions
within a few seconds or several hours after vaccine injection1. Our first case developed anaphylactic symptoms
within one minute after receiving the COVID-19 vaccine, while the second
one’s symptoms were revealed after seven hours. Moreover, both cases had
no history of previous allergic or anaphylactic reactions. Therefore, it
is necessary to follow-up individuals who undergo vaccine injection
during at least the first hours of vaccination.
Injection of the vaccine was performed with 2cc syringe without
aspiration, and unusual bleeding was observed without any bleeding
disorder. Therefore, IV administration of the vaccine may cause an early
anaphylactic reaction in the first case. Recommendations vary on
aspiration before vaccine injection 2. However, this
procedure is not currently recommended for COVID-19 vaccines3.
Diagnosis of anaphylactic shock is based on the patient’s clinical signs
and symptoms. Prompt treatment should be initiated as soon as the
anaphylactic shock is considered. Injection of IM epinephrine and IV
fluids is recommended as the first-line treatment for patients with
anaphylactic shock 1. After epinephrine
administration, IV hydrocortisone should be injected. However, our
patients were treated with hydrocortisone as the first-line drug for the
emergency treatment of anaphylaxis. An anaphylactic reaction could be
life-threatening, and any delay in treatment may increase the risk of
patient mortality 1. Therefore, healthcare providers
should be trained to treat anaphylactic events accurately, and required
equipment should be available.
Newly-made COVID-19 vaccines are currently authorized for emergency use
in many countries. Because of being novel, vaccine adverse events are
not fully known 4. Surveillance programs are necessary
to monitor for complications. This challenge is notable in developing
countries where infrastructure has some shortcomings. Hence, evidence
for adverse events may have some drawbacks for vaccines administrated in
developing countries.
References
1. Bousquet J, Agache I, Blain H, et al. Management of anaphylaxis due
to COVID-19 vaccines in the elderly. Allergy . 2021;n/a(n/a).
doi:https://doi.org/10.1111/all.14838
2. Petousis-Harris H. Vaccine injection technique and
reactogenicity—Evidence for practice. Vaccine .
2008;26(50):6299-6304. doi:https://doi.org/10.1016/j.vaccine.2008.08.052
3. center for disease control. Vaccine Administration. Epidemiology and
Prevention of Vaccine-Preventable Diseases. Published 2020.
https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html
4. Sampath V, Rabinowitz G, Shah M, et al. Vaccines and Allergic
reactions: the past, the current COVID-19 pandemic, and future
perspectives. Allergy . 2021;n/a(n/a).
doi:https://doi.org/10.1111/all.14840
Figure 1. Cyanosis and
swelling of hands 8 hours after receiving AstraZeneca Vaccine. Cyanosis
may be a cardiac-related symptom of anaphylaxis.