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COVID-19 Vaccine-Related eConsults: Case 10

eConsult Clinical Question

A 36-year-old woman with no significant past medical history received her first dose of Moderna. Two days later had a macular/papular rash to chest, back and between her brows. She started using Benadryl and then started to have an itch. She is unsure if the itch started before or after Benadryl. The Benadryl has not helped the itch and the rash has resolved. She has and no other new meds or exposures and had itching with oxycodone in the past. The patient stopped Benadryl last night but still has itching today. Can the patient proceed with dose two of vaccine? Any further recommendations for her itch beside trial of Zyrtec?

eConsult Response:  

  1. Restatement of Question: 36-year-old female with no significant past medical history who received her first dose of Moderna, two days later had a macular/papular rash to chest, back and between her brows. She started using Benadryl and then started to have an itch. Pt unsure if itch started before or after Benadryl. The Benadryl has not helped the itch and the rash has resolved. Itching remains in areas of rash as well as scalp region. No other new meds or exposures. Had itching with oxycodone in the past. Pt stopped Benadryl last night but still has itching today. Two questions: can patient proceed with dose two of vaccine? Any further recommendations for her itch beside trial of Zyrtec?
  2. Recommendations: Agree with cetirizine for itch, as well as moisturizer application. Rash appears consistent with a viral exanthem-type rash, likely triggered by immune response to vaccination. Per her records, this is similar to rash she typically gets when sick. Patient may proceed with dose #2 of Moderna COVID-19 vaccine as scheduled. Consider taking Zyrtec 10 mg once or twice daily after vaccination for 1 week to minimize recurrence.
  3. Rationale: Reviewed notes and pictures of rash.
  4. Contingency Plan: May refer to allergy if patient has continued concerns.

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.