Characteristics of immune response profile in patients with immediate allergic and autoimmune urticarial reactions induced by SARS-CoV-2 vaccines

Chuang Wei Wang, Chun Bing Chen, Chun Wei Lu, Wei Ti Chen, Rosaline Chung Yee Hui, Tsu Man Chiu, Min Hui Chi, Jing Chi Lin, Yu Huei Huang, Ya Ching Chang, Jennifer Wu, Kuan Yu Chen, Yang Yu Wei Lin, Tzong Yun Ger, Jing Yi Lin, Wan Ting Tsai, Yen Ju Pan, Wen Hung Chung*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

6 Scopus citations


Severe allergic reactions following SARS-COV-2 vaccination are generally rare, but the reactions are increasingly reported. Some patients may develop prolonged urticarial reactions following SARS-COV-2 vaccination. Herein, we investigated the risk factors and immune mechanisms for patients with SARS-COV-2 vaccines-induced immediate allergy and chronic urticaria (CU). We prospectively recruited and analyzed 129 patients with SARS-COV-2 vaccine–induced immediate allergic and urticarial reactions as well as 115 SARS-COV-2 vaccines–tolerant individuals from multiple medical centers during 2021–2022. The clinical manifestations included acute urticaria, anaphylaxis, and delayed to chronic urticaria developed after SARS-COV-2 vaccinations. The serum levels of histamine, IL-2, IL-4, IL-6, IL-8, IL-17 A, TARC, and PARC were significantly elevated in allergic patients comparing to tolerant subjects (P-values = 4.5 × 10−5–0.039). Ex vivo basophil revealed that basophils from allergic patients could be significantly activated by SARS-COV-2 vaccine excipients (polyethylene glycol 2000 and polysorbate 80) or spike protein (P-values from 3.5 × 10−4 to 0.043). Further BAT study stimulated by patients’ autoserum showed positive in 81.3% of patients with CU induced by SARS-COV-2 vaccination (P = 4.2 × 10−13), and the reactions could be attenuated by anti-IgE antibody. Autoantibodies screening also identified the significantly increased of IgE-anti–IL-24, IgG-anti–FcεRI, IgG-anti–thyroid peroxidase (TPO), and IgG-anti-thyroid–related proteins in SARS-COV-2 vaccines-induced CU patients comparing to SARS-COV-2 vaccines-tolerant controls (P-values = 4.6 × 10−10–0.048). Some patients with SARS-COV-2 vaccines-induced recalcitrant CU patients could be successfully treated with anti-IgE therapy. In conclusion, our results revealed that multiple vaccine components, inflammatory cytokines, and autoreactive IgG/IgE antibodies contribute to SARS-COV-2 vaccine–induced immediate allergic and autoimmune urticarial reactions.

Original languageEnglish
Article number103054
Pages (from-to)103054
JournalJournal of Autoimmunity
StatePublished - 07 2023

Bibliographical note

Copyright © 2023. Published by Elsevier Ltd.


  • Anti-TPO IgG
  • Autoreactive antibodies
  • Chronic urticaria
  • PEG
  • SARS-COV-2 vaccine
  • Humans
  • Immunoglobulin G
  • Vaccination
  • Immunity
  • COVID-19
  • SARS-CoV-2
  • Urticaria/diagnosis
  • COVID-19 Vaccines/adverse effects
  • Chronic Urticaria/metabolism


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