Pruritic annular erythematous eruption after receiving the COVID-19 vaccine Article Swipe

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Devon E. Cross , James Garritano , Amanda Zubek , Alicia J. Little ·

YOU? · · 2022 · Open Access · · DOI: https://doi.org/10.1097/jw9.0000000000000033

What is known about this subject in regard to women and their families? Women are more likely to experience adverse reactions to the COVID-19 vaccine, including both immediate and delayed cutaneous reactions. Vaccine hesitancy is affected by concerns about safety and misconceptions regarding vaccine effectiveness and side effects. Immediate hypersensitivity reactions including urticaria to mRNA COVID-19 vaccines may not be a contraindication to subsequent vaccination with the same vaccine; evaluation by an allergist-immunologist may be considered Question 1: What is the most likely diagnosis? A. Erythema Multiforme B. Pityriasis Rosea C. Urticaria Multiforme D. Guttate Psoriasis E. Cutaneous Lupus Erythematosus Correct answer: C. Urticaria multiforme (immediate-type hypersensitivity reaction) to COVID-19 vaccine. The key finding in this case was onset of rash suggestive of acute urticaria within 4 hours of receiving the COVID-19 vaccine. Urticaria multiforme is a morphological subtype of acute urticaria characterized by blanchable edematous annular or polycyclic erythematous plaques, often with a dusky center. Case A woman in her 20s presented with multiple pruritic, pink/red edematous annular blanching plaques with dusky-appearing centers on her face, neck, chest, back, and shoulders. Two weeks prior, 2 pruritic pink-red papules appeared on her face within 4 hours of her first dose of Pfizer-BioNTech COVID-19 vaccine. Within 24 hours, additional lesions appeared, and a 5-day taper of oral prednisone was prescribed. By day 5, all lesions resolved but recurred 24 hours later with increased number and diameter, and central clearing (Fig 1). Anithistamines, hydroxyzine and cetirizine, were prescribed, and lesions resolved within 24 to 48 hours. She had no new medications, anaphylaxis-type symptoms, known allergies, angioedema, or history of autoimmune disease or vaccine reaction. Laboratory test results included normal complete blood count, normal complete metabolic panel, and negative anti-nuclear antibody, anti-dsDNA, SS-A, SS-B, Sm, and Sm/RNP antibodies. A punch biopsy demonstrated superficial and deep lymphocytic infiltrate with occasional eosinophils.Fig. 1.: Physical examination findings at presentation. (A) Left side of face. (B) Upper and lower back.Discussion Cutaneous reactions are a common side effect of mRNA COVID vaccines, with >4% of patients who received the 2-dose mRNA COVID vaccine reporting a cutaneous reaction.1 After local hypersensitivity reactions, urticarial rashes are the second most common cutaneous reaction to mRNA COVID vaccines, occurring in 0.34 to 0.46% of patients after first vaccine dose, and 0.49 to 0.66% of patients previously urticaria-free after second vaccine dose.1 Key features in establishing a diagnosis of urticaria are the transient nature of lesions and resolution with antihistamines. As in our patient’s case, the majority of cutaneous reactions to mRNA vaccines occur in women with no dermatologic history or vaccine reaction history.2 Our patient’s case differs from typical post-vaccine urticarial rashes in 2 key aspects: the rash occurred within 4 hours of the first dose and her presentation was consistent with urticaria multiforme. Urticaria multiforme is a morphological subtype of acute urticaria characterized by blanchable edematous annular or polycyclic erythematous plaques, often with a dusky center. To our knowledge, in prior case series on post-COVID vaccination rashes, the morphology of urticarial rashes is not explicitly stated. In a case series of 414 patients with cutaneous adverse events after vaccination with either the Moderna or Pfizer COVID-19 vaccines, a minority of urticarial eruptions occurred within 24 hours after administration (3/37 of cases).2 Of the urticarial eruptions occurring within 24 hours, all 3 occurred after the second dose. Critically, while anaphylaxis is a contraindication to repeat vaccination with the same vaccine type, urticaria without anaphylaxis is not an absolute contraindication to additional vaccine doses.3 Management of patients with urticaria without anaphylaxis after vaccination may include referral to an allergist-immunologist prior to vaccination with the same vaccine type. Pretreatment with fexofenadine 180 to 360 mg or cetirizine 10 to 20 mg 1 to 2 hours prior to subsequent COVID-19 vaccination can be considered for patients with vaccine-associated urticaria.3 Notably, in patients who experienced an urticarial rash after their first vaccine dose, 2.02 to 5.03% developed an urticarial rash after their second dose,1 but the frequency with which patients may develop chronic urticaria after COVID-19 vaccination is unknown. In our patient’s case, after allergist-immunologist evaluation, she was tapered off antihistamines without recurrence. She then received her second Pfizer-BioNTech COVID-19 vaccination with antihistamine premedication of cetirizine 30 mg and famotidine 20 mg administered 30 minutes prior to vaccination, followed by 30 minutes monitoring post-injection without recurrence. Women are more likely to experience COVID-19 cutaneous vaccine-related side effects. Hence, we emphasize the importance of timely diagnosis, appropriate management, and clear communication and reassurance regarding the side effects of COVID-19 vaccines in women in order to support COVID-19 vaccination efforts and pandemic control. Question 2: What is the next best step in management? A. Prescribe systemic steroids and proceed with second dose of the same vaccine type. B. Prescribe hydroxychloroquine and refer to rheumatology before second dose of the same vaccine type. C. Prescribe topical steroids and proceed with second dose of the same vaccine type. D. Continue antihistamines and refer to allergy-immunology before second dose of the same vaccine type. Correct answer: D. Continue antihistamines and refer to allergy-immunology before second dose of the same vaccine type. Topical steroids (C) and hydroxychloroquine (B) may be used to treat cutaneous lupus, some forms of which may also present as annular pink plaques, but these are not beneficial in urticaria. Systemic steroids (A) may result in rebound urticaria, and patients with immediate allergic reactions to the COVID-19 vaccine should see allergy-immunology prior to second vaccine dose. Author contributions D.E.C.: writing - original draft preparation J.G.: writing - revisions, reviewing and editing A.E.Z.: conceptualization, writing - reviewing and editing, resources A.J.L.: conceptualization, supervision, writing - reviewing and editing, resources Conflicts of interest None. Funding None. Study approval N/A.

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Medicine Erythema multiforme Dermatology Pityriasis rosea Angioedema Erythema Granuloma annulare

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Landing Page: https://doi.org/10.1097/jw9.0000000000000033
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Title: Pruritic annular erythematous eruption after receiving the COVID-19 vaccine

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Publication year: 2022

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Authors: Devon E. Cross, James Garritano, Amanda Zubek, Alicia J. Little

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Concepts: Medicine, Erythema multiforme, Dermatology, Pityriasis rosea, Angioedema, Erythema, Granuloma annulare

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abstract_inverted_index.2	185, 441, 619
abstract_inverted_index.3	549
abstract_inverted_index.4	126, 194, 448
abstract_inverted_index.A	157, 295
abstract_inverted_index.a	60, 136, 153, 211, 326, 346, 393, 465, 482, 506, 526, 559
abstract_inverted_index.10	613
abstract_inverted_index.1:	77
abstract_inverted_index.20	615, 704
abstract_inverted_index.24	205, 227, 250, 533, 546
abstract_inverted_index.2:	766
abstract_inverted_index.30	700, 707, 714
abstract_inverted_index.48	252
abstract_inverted_index.5,	221
abstract_inverted_index.A.	84, 775
abstract_inverted_index.As	407
abstract_inverted_index.B.	87, 789
abstract_inverted_index.By	219
abstract_inverted_index.C.	90, 102, 804
abstract_inverted_index.D.	93, 818, 835
abstract_inverted_index.E.	96
abstract_inverted_index.In	505, 673
abstract_inverted_index.Of	540
abstract_inverted_index.To	485
abstract_inverted_index.an	71, 574, 594, 639, 651
abstract_inverted_index.as	870
abstract_inverted_index.at	311
abstract_inverted_index.be	59, 74, 627, 857
abstract_inverted_index.by	36, 70, 143, 472, 713
abstract_inverted_index.in	6, 114, 159, 367, 391, 408, 421, 440, 488, 635, 753, 755, 773, 879, 886
abstract_inverted_index.is	1, 34, 79, 135, 464, 501, 558, 572, 671, 768
abstract_inverted_index.mg	610, 616, 701, 705
abstract_inverted_index.no	256, 424
abstract_inverted_index.of	119, 122, 128, 139, 196, 200, 214, 266, 316, 330, 336, 371, 381, 395, 401, 414, 450, 468, 498, 509, 528, 538, 582, 698, 736, 750, 784, 799, 813, 828, 845, 865, 940
abstract_inverted_index.on	174, 190, 492
abstract_inverted_index.or	147, 264, 269, 427, 476, 522, 611
abstract_inverted_index.to	8, 17, 21, 53, 62, 108, 251, 362, 369, 379, 417, 561, 577, 593, 597, 608, 614, 618, 622, 648, 710, 724, 757, 794, 823, 840, 859, 895, 903
abstract_inverted_index.we	732
abstract_inverted_index.(A)	313, 883
abstract_inverted_index.(B)	318, 855
abstract_inverted_index.(C)	852
abstract_inverted_index.1).	239
abstract_inverted_index.1.:	307
abstract_inverted_index.180	607
abstract_inverted_index.20s	161
abstract_inverted_index.360	609
abstract_inverted_index.414	510
abstract_inverted_index.>4%	335
abstract_inverted_index.Key	389
abstract_inverted_index.Our	431
abstract_inverted_index.She	254, 687
abstract_inverted_index.Sm,	291
abstract_inverted_index.The	111
abstract_inverted_index.Two	182
abstract_inverted_index.all	222, 548
abstract_inverted_index.and	10, 28, 40, 45, 180, 210, 233, 235, 242, 246, 284, 292, 300, 320, 377, 403, 454, 702, 741, 744, 762, 779, 792, 808, 821, 838, 853, 889, 920, 927, 936
abstract_inverted_index.are	14, 325, 355, 397, 721, 876
abstract_inverted_index.but	225, 658, 874
abstract_inverted_index.can	626
abstract_inverted_index.day	220
abstract_inverted_index.for	629
abstract_inverted_index.had	255
abstract_inverted_index.her	160, 175, 191, 197, 455, 690
abstract_inverted_index.key	112, 442
abstract_inverted_index.may	57, 73, 590, 664, 856, 867, 884
abstract_inverted_index.new	257
abstract_inverted_index.not	58, 502, 573, 877
abstract_inverted_index.off	683
abstract_inverted_index.our	409, 486, 674
abstract_inverted_index.see	900
abstract_inverted_index.she	680
abstract_inverted_index.the	22, 66, 80, 130, 340, 356, 398, 412, 444, 451, 496, 520, 541, 552, 565, 600, 659, 734, 747, 769, 785, 800, 814, 829, 846, 896
abstract_inverted_index.was	117, 217, 457, 681
abstract_inverted_index.who	338, 637
abstract_inverted_index.(Fig	238
abstract_inverted_index.0.34	368
abstract_inverted_index.0.49	378
abstract_inverted_index.2.02	647
abstract_inverted_index.Case	156
abstract_inverted_index.Left	314
abstract_inverted_index.N/A.	947
abstract_inverted_index.What	0, 78, 767
abstract_inverted_index.also	868
abstract_inverted_index.best	771
abstract_inverted_index.both	26
abstract_inverted_index.case	116, 433, 490, 507
abstract_inverted_index.deep	301
abstract_inverted_index.dose	199, 453, 783, 798, 812, 827, 844
abstract_inverted_index.face	192
abstract_inverted_index.from	435
abstract_inverted_index.mRNA	54, 331, 342, 363, 418
abstract_inverted_index.more	15, 722
abstract_inverted_index.most	81, 358
abstract_inverted_index.next	770
abstract_inverted_index.oral	215
abstract_inverted_index.pink	872
abstract_inverted_index.rash	120, 445, 641, 653
abstract_inverted_index.same	67, 566, 601, 786, 801, 815, 830, 847
abstract_inverted_index.side	46, 315, 328, 729, 748
abstract_inverted_index.some	863
abstract_inverted_index.step	772
abstract_inverted_index.test	273
abstract_inverted_index.then	688
abstract_inverted_index.this	4, 115
abstract_inverted_index.used	858
abstract_inverted_index.were	244
abstract_inverted_index.with	65, 152, 163, 171, 230, 304, 334, 405, 423, 459, 481, 512, 518, 564, 584, 599, 605, 631, 661, 695, 781, 810, 891
abstract_inverted_index.(3/37	537
abstract_inverted_index.0.46%	370
abstract_inverted_index.0.66%	380
abstract_inverted_index.5-day	212
abstract_inverted_index.5.03%	649
abstract_inverted_index.After	349
abstract_inverted_index.COVID	332, 343, 364
abstract_inverted_index.J.G.:	915
abstract_inverted_index.Lupus	98
abstract_inverted_index.None.	942, 944
abstract_inverted_index.Rosea	89
abstract_inverted_index.SS-A,	289
abstract_inverted_index.SS-B,	290
abstract_inverted_index.Study	945
abstract_inverted_index.Upper	319
abstract_inverted_index.Women	13, 720
abstract_inverted_index.about	3, 38
abstract_inverted_index.acute	123, 140, 469
abstract_inverted_index.after	373, 385, 516, 535, 551, 588, 642, 654, 668, 677
abstract_inverted_index.back,	179
abstract_inverted_index.blood	278
abstract_inverted_index.case,	411, 676
abstract_inverted_index.clear	742
abstract_inverted_index.dose,	376, 646
abstract_inverted_index.dose.	554, 906
abstract_inverted_index.draft	913
abstract_inverted_index.dusky	154, 483
abstract_inverted_index.face,	176
abstract_inverted_index.face.	317
abstract_inverted_index.first	198, 374, 452, 644
abstract_inverted_index.forms	864
abstract_inverted_index.hours	127, 195, 228, 449, 534, 620
abstract_inverted_index.known	2, 261
abstract_inverted_index.later	229
abstract_inverted_index.local	350
abstract_inverted_index.lower	321
abstract_inverted_index.neck,	177
abstract_inverted_index.occur	420
abstract_inverted_index.often	151, 480
abstract_inverted_index.onset	118
abstract_inverted_index.order	756
abstract_inverted_index.prior	489, 596, 621, 709, 902
abstract_inverted_index.punch	296
abstract_inverted_index.refer	793, 822, 839
abstract_inverted_index.taper	213
abstract_inverted_index.their	11, 643, 655
abstract_inverted_index.these	875
abstract_inverted_index.treat	860
abstract_inverted_index.type,	568
abstract_inverted_index.type.	603, 788, 803, 817, 832, 849
abstract_inverted_index.weeks	183
abstract_inverted_index.which	662, 866
abstract_inverted_index.while	556
abstract_inverted_index.woman	158
abstract_inverted_index.women	9, 422, 754
abstract_inverted_index.2-dose	341
abstract_inverted_index.Author	907
abstract_inverted_index.Hence,	731
abstract_inverted_index.Pfizer	523
abstract_inverted_index.Sm/RNP	293
abstract_inverted_index.Within	204
abstract_inverted_index.before	796, 825, 842
abstract_inverted_index.biopsy	297
abstract_inverted_index.chest,	178
abstract_inverted_index.common	327, 359
abstract_inverted_index.count,	279
abstract_inverted_index.dose,1	657
abstract_inverted_index.dose.1	388
abstract_inverted_index.effect	329
abstract_inverted_index.either	519
abstract_inverted_index.events	515
abstract_inverted_index.hours,	206, 547
abstract_inverted_index.hours.	253
abstract_inverted_index.likely	16, 82, 723
abstract_inverted_index.lupus,	862
abstract_inverted_index.nature	400
abstract_inverted_index.normal	276, 280
abstract_inverted_index.number	232
abstract_inverted_index.panel,	283
abstract_inverted_index.prior,	184
abstract_inverted_index.rashes	354, 439, 500
abstract_inverted_index.regard	7
abstract_inverted_index.repeat	562
abstract_inverted_index.result	885
abstract_inverted_index.safety	39
abstract_inverted_index.second	357, 386, 553, 656, 691, 782, 797, 811, 826, 843, 904
abstract_inverted_index.series	491, 508
abstract_inverted_index.should	899
abstract_inverted_index.timely	737
abstract_inverted_index.within	125, 193, 249, 447, 532, 545
abstract_inverted_index.A.E.Z.:	922
abstract_inverted_index.A.J.L.:	930
abstract_inverted_index.Correct	100, 833
abstract_inverted_index.D.E.C.:	909
abstract_inverted_index.Funding	943
abstract_inverted_index.Guttate	94
abstract_inverted_index.Moderna	521
abstract_inverted_index.Topical	850
abstract_inverted_index.Vaccine	32
abstract_inverted_index.adverse	19, 514
abstract_inverted_index.annular	146, 168, 475, 871
abstract_inverted_index.answer:	101, 834
abstract_inverted_index.center.	155, 484
abstract_inverted_index.centers	173
abstract_inverted_index.central	236
abstract_inverted_index.chronic	666
abstract_inverted_index.delayed	29
abstract_inverted_index.develop	665
abstract_inverted_index.differs	434
abstract_inverted_index.disease	268
abstract_inverted_index.doses.3	580
abstract_inverted_index.editing	921
abstract_inverted_index.effects	749
abstract_inverted_index.efforts	761
abstract_inverted_index.finding	113
abstract_inverted_index.history	265, 426
abstract_inverted_index.include	591
abstract_inverted_index.lesions	208, 223, 247, 402
abstract_inverted_index.minutes	708, 715
abstract_inverted_index.papules	188
abstract_inverted_index.plaques	170
abstract_inverted_index.present	869
abstract_inverted_index.proceed	780, 809
abstract_inverted_index.rashes,	495
abstract_inverted_index.rebound	887
abstract_inverted_index.results	274
abstract_inverted_index.stated.	504
abstract_inverted_index.subject	5
abstract_inverted_index.subtype	138, 467
abstract_inverted_index.support	758
abstract_inverted_index.tapered	682
abstract_inverted_index.topical	806
abstract_inverted_index.typical	436
abstract_inverted_index.vaccine	43, 270, 344, 375, 387, 428, 567, 579, 602, 645, 787, 802, 816, 831, 848, 898, 905
abstract_inverted_index.without	570, 586, 685, 718
abstract_inverted_index.writing	910, 916, 924, 933
abstract_inverted_index.COVID-19	23, 55, 109, 131, 202, 524, 624, 669, 693, 726, 751, 759, 897
abstract_inverted_index.Continue	819, 836
abstract_inverted_index.Erythema	85
abstract_inverted_index.Notably,	634
abstract_inverted_index.Physical	308
abstract_inverted_index.Question	76, 765
abstract_inverted_index.Systemic	881
abstract_inverted_index.absolute	575
abstract_inverted_index.affected	35
abstract_inverted_index.allergic	893
abstract_inverted_index.appeared	189
abstract_inverted_index.approval	946
abstract_inverted_index.aspects:	443
abstract_inverted_index.cases).2	539
abstract_inverted_index.clearing	237
abstract_inverted_index.complete	277, 281
abstract_inverted_index.concerns	37
abstract_inverted_index.control.	764
abstract_inverted_index.editing,	928, 937
abstract_inverted_index.effects.	47, 730
abstract_inverted_index.features	390
abstract_inverted_index.findings	310
abstract_inverted_index.followed	712
abstract_inverted_index.included	275
abstract_inverted_index.interest	941
abstract_inverted_index.majority	413
abstract_inverted_index.minority	527
abstract_inverted_index.multiple	164
abstract_inverted_index.negative	285
abstract_inverted_index.occurred	446, 531, 550
abstract_inverted_index.original	912
abstract_inverted_index.pandemic	763
abstract_inverted_index.patients	337, 372, 382, 511, 583, 630, 636, 663, 890
abstract_inverted_index.pink-red	187
abstract_inverted_index.pink/red	166
abstract_inverted_index.plaques,	150, 479, 873
abstract_inverted_index.pruritic	186
abstract_inverted_index.reaction	361, 429
abstract_inverted_index.received	339, 689
abstract_inverted_index.recurred	226
abstract_inverted_index.referral	592
abstract_inverted_index.resolved	224, 248
abstract_inverted_index.steroids	778, 807, 851, 882
abstract_inverted_index.systemic	777
abstract_inverted_index.unknown.	672
abstract_inverted_index.vaccine,	24
abstract_inverted_index.vaccine.	110, 132, 203
abstract_inverted_index.vaccine;	68
abstract_inverted_index.vaccines	56, 419, 752
abstract_inverted_index.Conflicts	939
abstract_inverted_index.Cutaneous	97, 323
abstract_inverted_index.Immediate	48
abstract_inverted_index.Prescribe	776, 790, 805
abstract_inverted_index.Psoriasis	95
abstract_inverted_index.Urticaria	91, 103, 133, 462
abstract_inverted_index.antibody,	287
abstract_inverted_index.appeared,	209
abstract_inverted_index.blanching	169
abstract_inverted_index.cutaneous	30, 347, 360, 415, 513, 727, 861
abstract_inverted_index.developed	650
abstract_inverted_index.diagnosis	394
abstract_inverted_index.diameter,	234
abstract_inverted_index.edematous	145, 167, 474
abstract_inverted_index.emphasize	733
abstract_inverted_index.eruptions	530, 543
abstract_inverted_index.families?	12
abstract_inverted_index.frequency	660
abstract_inverted_index.hesitancy	33
abstract_inverted_index.history.2	430
abstract_inverted_index.immediate	27, 892
abstract_inverted_index.including	25, 51
abstract_inverted_index.increased	231
abstract_inverted_index.metabolic	282
abstract_inverted_index.occurring	366, 544
abstract_inverted_index.presented	162
abstract_inverted_index.pruritic,	165
abstract_inverted_index.reaction)	107
abstract_inverted_index.reaction.	271
abstract_inverted_index.reactions	20, 50, 324, 416, 894
abstract_inverted_index.receiving	129
abstract_inverted_index.regarding	42, 746
abstract_inverted_index.reporting	345
abstract_inverted_index.resources	929, 938
abstract_inverted_index.reviewing	919, 926, 935
abstract_inverted_index.symptoms,	260
abstract_inverted_index.transient	399
abstract_inverted_index.urticaria	52, 124, 141, 396, 460, 470, 569, 585, 667
abstract_inverted_index.vaccines,	333, 365, 525
abstract_inverted_index.Laboratory	272
abstract_inverted_index.Management	581
abstract_inverted_index.Multiforme	86, 92
abstract_inverted_index.Pityriasis	88
abstract_inverted_index.additional	207, 578
abstract_inverted_index.allergies,	262
abstract_inverted_index.autoimmune	267
abstract_inverted_index.beneficial	878
abstract_inverted_index.blanchable	144, 473
abstract_inverted_index.cetirizine	612, 699
abstract_inverted_index.considered	75, 628
abstract_inverted_index.consistent	458
abstract_inverted_index.diagnosis,	738
abstract_inverted_index.diagnosis?	83
abstract_inverted_index.evaluation	69
abstract_inverted_index.experience	18, 725
abstract_inverted_index.explicitly	503
abstract_inverted_index.famotidine	703
abstract_inverted_index.importance	735
abstract_inverted_index.infiltrate	303
abstract_inverted_index.knowledge,	487
abstract_inverted_index.monitoring	716
abstract_inverted_index.morphology	497
abstract_inverted_index.multiforme	104, 134, 463
abstract_inverted_index.occasional	305
abstract_inverted_index.polycyclic	148, 477
abstract_inverted_index.post-COVID	493
abstract_inverted_index.prednisone	216
abstract_inverted_index.previously	383
abstract_inverted_index.reaction.1	348
abstract_inverted_index.reactions,	352
abstract_inverted_index.reactions.	31
abstract_inverted_index.resolution	404
abstract_inverted_index.revisions,	918
abstract_inverted_index.shoulders.	181
abstract_inverted_index.subsequent	63, 623
abstract_inverted_index.suggestive	121
abstract_inverted_index.urticaria,	888
abstract_inverted_index.urticaria.	880
abstract_inverted_index.urticarial	353, 438, 499, 529, 542, 640, 652
abstract_inverted_index.Critically,	555
abstract_inverted_index.anaphylaxis	557, 571, 587
abstract_inverted_index.angioedema,	263
abstract_inverted_index.anti-dsDNA,	288
abstract_inverted_index.antibodies.	294
abstract_inverted_index.appropriate	739
abstract_inverted_index.cetirizine,	243
abstract_inverted_index.evaluation,	679
abstract_inverted_index.examination	309
abstract_inverted_index.experienced	638
abstract_inverted_index.hydroxyzine	241
abstract_inverted_index.lymphocytic	302
abstract_inverted_index.management,	740
abstract_inverted_index.management?	774
abstract_inverted_index.multiforme.	461
abstract_inverted_index.patient’s	410, 432, 675
abstract_inverted_index.preparation	914
abstract_inverted_index.prescribed,	245
abstract_inverted_index.prescribed.	218
abstract_inverted_index.reassurance	745
abstract_inverted_index.recurrence.	686, 719
abstract_inverted_index.superficial	299
abstract_inverted_index.urticaria.3	633
abstract_inverted_index.vaccination	64, 494, 517, 563, 589, 598, 625, 670, 694, 760
abstract_inverted_index.Pretreatment	604
abstract_inverted_index.administered	706
abstract_inverted_index.anti-nuclear	286
abstract_inverted_index.demonstrated	298
abstract_inverted_index.dermatologic	425
abstract_inverted_index.erythematous	149, 478
abstract_inverted_index.establishing	392
abstract_inverted_index.fexofenadine	606
abstract_inverted_index.medications,	258
abstract_inverted_index.post-vaccine	437
abstract_inverted_index.presentation	456
abstract_inverted_index.rheumatology	795
abstract_inverted_index.supervision,	932
abstract_inverted_index.vaccination,	711
abstract_inverted_index.Erythematosus	99
abstract_inverted_index.antihistamine	696
abstract_inverted_index.characterized	142, 471
abstract_inverted_index.communication	743
abstract_inverted_index.contributions	908
abstract_inverted_index.effectiveness	44
abstract_inverted_index.morphological	137, 466
abstract_inverted_index.premedication	697
abstract_inverted_index.presentation.	312
abstract_inverted_index.administration	536
abstract_inverted_index.antihistamines	684, 820, 837
abstract_inverted_index.misconceptions	41
abstract_inverted_index.post-injection	717
abstract_inverted_index.urticaria-free	384
abstract_inverted_index.(immediate-type	105
abstract_inverted_index.Anithistamines,	240
abstract_inverted_index.Pfizer-BioNTech	201, 692
abstract_inverted_index.antihistamines.	406
abstract_inverted_index.back.Discussion	322
abstract_inverted_index.dusky-appearing	172
abstract_inverted_index.vaccine-related	728
abstract_inverted_index.anaphylaxis-type	259
abstract_inverted_index.contraindication	61, 560, 576
abstract_inverted_index.eosinophils.Fig.	306
abstract_inverted_index.hypersensitivity	49, 106, 351
abstract_inverted_index.allergy-immunology	824, 841, 901
abstract_inverted_index.conceptualization,	923, 931
abstract_inverted_index.hydroxychloroquine	791, 854
abstract_inverted_index.vaccine-associated	632
abstract_inverted_index.allergist-immunologist	72, 595, 678
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cited_by_percentile_year.min	89
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countries_distinct_count	1
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