” COVID ARM, “another new term?

As COVID-19 vaccination rolls out in the United States, some side effects aren’ t just being reported in the literature or the news media. Patients turn to their GP for discomfort wherever they get the vaccine, and recently saw a case of Bells Palsy, an extremely rare case that occurred in just six of 34, 000 patients enrolled in Moderna’s phase iii trial with Pfizer. But when the coronavirus vaccine is under the spotlight, any side effects that might be associated with it are magnified, and recently patients have started seeing doctors about a rash at the injection site — a skin reaction known as “COVID ARM”.

What is a “COVID arm” ?

The term “COVID arm” refers to redness, swelling, pain, itching, and even indentation near the site of vaccination one week after the first dose of the Moderna vaccine. As you know, local reactions at the injection site are quite common, but they usually occur within a few hours or 1-2 days after vaccination. What’s special about “COVID ARM” is that it appears around 8-10 days after vaccination, and the size and shape of the rash can vary but can be up to 6 inches. According to Baden et al., the incidence in phase 3 clinical trials was 0. 8%(after the first dose) and 0. 2%(after the second dose).

Is “COVID Arm” harmful?

“COVID ARM” is not a skin infection at the injection site that does not require antibiotic treatment, but rather a delayed allergic reaction, a local reaction of the body’s immune system to a vaccine. According to clinical trials and follow-up studies of vaccine side effects, “COVID ARM” was seen mostly after treatment with Moderna and, to a lesser extent, Pfizer. At present, it is not completely clear why this mild allergic reaction occurs in a small number of people. Skin biopsy findings may be related to t-cell-mediated immune response, but it is currently believed that this “COVID ARM” does not cause long-term harm.

What should I do if “COVID ARM” occurs after inoculation?

For the treatment of delayed anaphylaxis, nonsteroidal anti-inflammatory drugs (such as ibuprofen) combined with antihistamines (such as Benadryl) and OTC hydrocortisone creams or cold compressions are recommended to relieve pain. This delayed local skin reaction usually disappears within 4-5 days. If the rash persists for more than a week or if it appears in a location other than the injection site or if you have systemic symptoms, you are advised to seek help from your doctor, and CDC also encourages you to report any side effects that may be associated with the COVID-19 vaccine (via V-Safe).

The most important question is if you get COVID ARM after the first dose, will it happen again after the second dose?

A recent study published in the New England Journal of Medicine analyzed 12 patients who developed COVID ARM after receiving the first dose of Moderna’s vaccine. To be clear, this delayed anaphylaxis is not a contraindication to the second dose of the vaccine. Half of the 12 patients in the study did not develop any rashes after the second dose; Three of the patients developed rashes similar to the first dose, and three had milder rashes. However, the onset of the rash was significantly earlier after the second dose (on average, the second day). In summary, we still recommend that you continue to receive the second dose of the vaccine. The threat to your body from contracting COVID-19 will far outweigh the distress caused by “COVID ARM”.