Rare, Usually Don’t Recur After Second Dose

The study’s findings offer reassurance to those concerned about vaccination.

Skin problems such as itching, rashes, hives and swelling may occur in some individuals after receiving a COVID-19 vaccine, but it is not clear how often these reactions occur or how often they recur with a subsequent vaccination. Research led by allergists at Massachusetts General Hospital (MGH) now provides encouraging evidence that reactions are rare, and that even when they occur with a first COVID-19 vaccination, they rarely recur after receiving a second vaccine dose.

For the study, which is published in JAMA Dermatology, a team led by Kimberly G. Blumenthal, MD, MSc, co-director of the Clinical Epidemiology Program within the Division of Rheumatology, Allergy and Immunology at MGH, prospectively recruited 49,197 Mass General Brigham employees studied who received mRNA COVID-19 vaccines. At least one symptom survey was completed by 40,640 workers after the first dose of vaccine.

Skin reactions were reported by 776 (1.9%) of survey respondents after the first dose. Rash and itching (other than at the injection site) were the most common skin reactions, and the mean age of those reporting skin reactions was 41 years. Skin reactions were more common in women (85%) than in men (15%) and varied by race (62% Caucasian, 7% Black, and 12% Asian).

Of the 609 subjects who reported skin reactions to the first dose, received a second dose, and completed a symptom study after the second dose, 508 (83%) reported no recurrent skin reactions.

Of the subjects with no skin reaction to the first dose, 2.3% reported skin reactions after the second dose, with rash and itching being the most common.

“This is the first information we have on the risk of recurrence of skin reactions after dose 2 when there is a dose 1 response. Our findings may provide critical reassurance to people with rashes, hives and swelling after dose 1 of their mRNA vaccines,” said Blumenthal.

Lead author Lacey B. Robinson, MD, MPH, allergist and researcher at MGH, adds that skin reactions alone shouldn’t be a reason to skip the second dose, especially since most don’t recur on the next dose. “For those who occur within hours of vaccination, or for severe reactions at any time, patients should see an allergist or immunologist who can evaluate and supervise dose 2 vaccination,” she says.

Reference: “Incidence of Skin Reactions After Messenger RNA COVID-19 Vaccines” by Lacey B. Robinson, MD, MPH; Xiaoqing Fu, MS; Dean Hashimoto, MD; Paige Wickner, MD, MPH; Erica S. Shenoy, MD, PhD; Adam B. Landman, MD and Kimberly G. Blumenthal, MD, MSc, June 23, 2021, JAMA Dermatology.
DOI: 10.1001 / jamadermatol.2021.2114

Co-authors include Xiaoqing Fu, MS, Dean Hashimoto, MD, and Erica S. Shenoy, MD, PhD, of MGH and Paige Wickner, MD, MPH, and Adam B. Landman, MD, of Brigham and Women’s Hospital.

This work was supported by National Institutes of Health and the MGH Department of Medicine Transformative Scholar Program.