Background: Patients affected by pre-existing chronic spontaneous/Inducible urticaria (CSU/CIU) still feel unsafe due to the potential risk of an Adverse Event Following Immunization (AEFI) and Cutaneous Adverse Reactions (CARs) of COVID-19 vaccines. The appropriate management in this field remains debated and evidence is still lacking. Methods: We considered 160 CSU/CIU patients in Omalizumab/antihistamine therapy who received two doses of Comirnaty/Moderna mRNA vaccines; 20 of them also received a booster dose. Urticaria Activity Score-7 (UAS7) was used to assess the severity of the disease. Demographics, medical history, AEFI and CARs outcome after vaccination were collected by administering a web-based questionnaire completed by phone interview. Results: In total, 147 patients did not show urticaria relapse (91.88%). Worsening cutaneous symptoms were experienced by 13 of our patients (8.12%). Exacerbation had a mean duration of 2 days and 11 h and mostly occurred after the first dose (69.23%). Systemic mild side effects were experienced by 9 patients (5.62%). No severe reactions were observed. Conclusions: Omalizumab can potentially prevent CARs and AEFI; however, major problems were registered during the 2-month stop period scheduled in the treatment. We suggest patients should not undergo vaccination during this period. CSU/CIU exacerbations appear to be transient and can be managed by antihistamines.

Urbach-Wiethe syndrome, also known as lipoid proteinosis (LP), is a rare genodermatosis clinically characterized by mucocutaneous lesions, dysphonia with onset in early childhood, and, sometimes, neurological complications. Clinical signs, as well as the severity of the disease, are highly variable, while its course is usually slowly progressive. The typical primary sign is hoarse crying due to laryngeal infiltration at birth or during early childhood. Alterations of the skin and mucous membranes develop within the first two years of life. The skin lesions initially appear on the face and limbs and usually resolve by healing. Infiltration of the respiratory system can cause upper respiratory tract infections, hoarseness or aphonia, dysphagia, and even airway obstruction. Dystonia, epileptic seizures, and learning disorders may be observed in affected children. Treatment remains a major challenge as no standardized therapies exist, but oral acitretin appears to be effective in improving skin manifestations. We report two clinical cases of young women suffering from LP, presenting with dermatological, otorhinolaryngological, and neurological symptoms, currently referred to our Rare Cutaneous Syndrome Center at the Policlinico Umberto I in Rome (Italy).