COVID-19疫苗的過敏和風濕性不良反應：單一醫學中心的回顧性研究

Allergic and Rheumatic Adverse Reactions to COVID-19 Vaccination: A Tertiary Medical Center Retrospective Study

目的：由於COVID-19大流行，COVID-19疫苗的開發和緊急批准被加快，其中一些疫苗被報導引發多種不良反應。本研究是在臺灣中部一所三級醫療中心評估COVID-19疫苗的過敏和風濕不良反應。
方法：共收集1305例，自2021年3月至2022年8月，來自台中榮總不良反應報告系統資料庫的病例。其中，220例為COVID-19疫苗相關的不良反應。總共有66例疫苗相關的過敏和風濕反應患者被納入研究。
結果：AZD1222/ChAdOx1、mRNA-1273、Pfizer-BioNTec和MVC-COV1901疫苗的病例均被包括在內。不良反應主要發生在第一劑。過敏反應主要發生在接種後一周內，尤其是接種當天。非蕁麻疹性皮疹多為輕度，是最常報告的過敏不良反應；有3例過敏性休克事件，雖然可能危及生命，但所有患者在24小時內出院，且症狀完全緩解。十例新發的風濕病例發生在接種後4周內，所有患者都需要疾病修飾性抗風濕藥（DMARDs）和免疫抑制劑。
結論：總體而言，COVID-19疫苗相關的過敏不良反應較輕，即使罕見的過敏性休克事件也是可以處理的。儘管COVID-19疫苗與風濕疾病之間的因果關係仍不清楚，但是任何接種後新發或加重的風濕疾病必須及時治療以避免不良結果。

Background: Due to the COVID-19 pandemic, there was a hastening in the development and emergency approval of COVID-19 vaccines. Some of these vaccines were reported to induce multiple adverse reactions. This study evaluated the adverse reactions from COVID-19 vaccination from both the allergic and rheumatic standpoints at a tertiary medical center in central Taiwan.
Method: In total, 1305 cases were collected from the Taichung Veterans General Hospital (TCVGH)- Adverse Drug Reaction (ADR) reporting system database between March 2021 to August 2022. Among them, 220 cases were of COVID-19 vaccination-related adverse reactions. In total, 66 patients with vaccine-related allergic and rheumatic reactions were enrolled in the study.
Results: The cases of AZD1222/ChAdOx1, mRNA-1273, Pfizer-BioNTec, and MVC-COV1901 vaccines were included, showing significant adverse reactions after the first dose. The allergic reactions mainly happened within a week post-vaccination, particularly on the same day of vaccination. Non-urticarial skin rashes, classified as mild, were the most commonly reported allergic adverse reactions. There were 3 cases of anaphylactic events. Though life-threatening, all of them were discharged within 24 hours with symptom-free. Ten de-novo rheumatic cases happened within 4 weeks post-vaccination and all required disease-modifying antirheumatic drugs (DMARDs) and immunosuppressive agents.
Conclusion: In general, COVID-19 vaccines associated allergic adverse reactions were mild, and even the rare life-threatening anaphylaxis events were considerably manageable. Although the causal relationship between rheumatic diseases and COVID-19 vaccines is still not clear, any new onset or worsening of pre-existing rheumatic diseases after vaccination must be treated promptly to avoid poor outcomes.