Management of Urticaria in COVID‐19 Patients: A Systematic Review

Abstract

Objectives: The global pandemic COVID‐19 has resulted in significant global morbidity, mortality and increased healthcare demands. There is now emerging evidence in of patients experiencing urticaria. We sought to systematically review current evidence, critique the literature and present out findings. Methods: Allowing PRISMA guidelines, a comprehensive literature search was carried out with Medline, EMBASE, Scopus, Cochrane, and Google Scholar, using key MeSH words, which include “COVID‐19,” “Coronavirus”, “SARS‐Cov‐2”, “Urticaria,” “Angioedema,” “Skin rash” up to August, 01 2020. The key inclusion criteria were articles that reported on urticaria and/or angioedema due to COVID‐19 infection and reported management and outcome. Studies were excluded if no case or cohort outcomes were observed. Results: Our search returned 169 articles, 25 of which met inclusion criteria. All studies were case reports, reporting 26 patients with urticaria and/or angioedema and COVID‐19 infection and their management and/or response. Majority of patients (n=16, 69%) were over 50 years old. However, urticaria in the younger ages was not uncommon, with reported case of 2 months old infant. Skin lesions resolved from less than 24 hours to up to 2 weeks following treatment with antihistamines and/or steroids. There have been no cases of recurrent urticaria or cases non‐responsive to steroids. Conclusions: Management of urticarial in COVID‐19 patients should involve antihistamines. Low dose prednisolone should be considered on an individualised basis. Further research is required in understanding urticarial pathogenesis in COVID‐19. This will aid early diagnostic assessment in patients with high index of suspicion and subsequent management in the acute phase.