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  1. Article ; Online: Anaphylaxis After the Covid-19 Vaccine in a Patient With Cholinergic Urticaria.

    Park, Hyun J / Montgomery, Jay R / Boggs, Nathan A

    Military medicine

    2021  Volume 187, Issue 9, Page(s) e1556–e1558

    Abstract: Cholinergic urticaria is a common disorder that has been associated with anaphylaxis. We report the events, workup, and eventual second dose vaccination of a patient at the Walter Reed National Military Medical Center, who had immediate anaphylaxis after ...

    Abstract Cholinergic urticaria is a common disorder that has been associated with anaphylaxis. We report the events, workup, and eventual second dose vaccination of a patient at the Walter Reed National Military Medical Center, who had immediate anaphylaxis after administration of the first Pfizer-BioNTech Covid-19 (BNT162b2) vaccine dose. During the initial evaluation after anaphylaxis, the patient described a history of symptoms suspicious for cholinergic urticaria but had never had this condition confirmed with standardized testing. After the episode of anaphylaxis, we performed several studies including immediate hypersensitivity skin testing, which did not demonstrate vaccine or component sensitization. We then performed an exercise provocation challenge and confirmed the diagnosis of cholinergic urticaria. These results, combined with the patient history, suggested that the episode of anaphylaxis was most likely driven by a severe flare of cholinergic urticaria. After obtaining the patient's consent, she received and tolerated her second dose without any objective findings of anaphylaxis. We conclude that patients with mast cell disorders or anaphylaxis after their first Covid-19 immunization will benefit from referral to an allergist since receipt of their second Covid-19 immunization may be possible.
    MeSH term(s) Female ; Humans ; Anaphylaxis/etiology ; Anaphylaxis/diagnosis ; BNT162 Vaccine/adverse effects ; Cholinergic Agents ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Urticaria/complications
    Chemical Substances BNT162 Vaccine ; Cholinergic Agents ; COVID-19 Vaccines
    Language English
    Publishing date 2021-03-31
    Publishing country England
    Document type Case Reports
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usab138
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  2. Article ; Online: ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY AFTER IMMUNIZATION WITH MULTIPLE VACCINES.

    Kraemer, Laura S / Montgomery, Jay R / Baker, Katherine M / Colyer, Marcus H

    Retinal cases & brief reports

    2020  Volume 16, Issue 1, Page(s) 16–19

    Abstract: Purpose: To report a case of acute posterior multifocal placoid pigment epitheliopathy occurring in temporal association with multiple immunizations in a previously healthy 25-year-old woman.: Methods: Acute posterior multifocal placoid pigment ... ...

    Abstract Purpose: To report a case of acute posterior multifocal placoid pigment epitheliopathy occurring in temporal association with multiple immunizations in a previously healthy 25-year-old woman.
    Methods: Acute posterior multifocal placoid pigment epitheliopathy was diagnosed based on ophthalmological findings of bilateral placoid subretinal lesions complicated by a serous retinal detachment in the left eye.
    Results: Through HLA typing, the patient was found to possess the HLA-B*40 and HLA-DB1*15 alleles. She was treated with topical prednisolone acetate 1% and monitored for several months. The serous retinal detachment resolved, and visual acuity returned to normal.
    Conclusion: This case report adds to the body of knowledge regarding possible atypical interplay between vaccines and specific T-cell receptors of the host immune system and adds Polio and Tetanus to the growing list of vaccines potentially triggering acute posterior multifocal placoid pigment epitheliopathy. Increased awareness of the presentation of acute posterior multifocal placoid pigment epitheliopathy and that it may arise after immunization may also improve evaluation of acute changes in visual acuity.
    MeSH term(s) Adult ; Female ; Humans ; Vaccines/adverse effects ; White Dot Syndromes/diagnosis
    Chemical Substances Vaccines
    Language English
    Publishing date 2020-01-27
    Publishing country United States
    Document type Case Reports
    ISSN 1937-1578
    ISSN (online) 1937-1578
    DOI 10.1097/ICB.0000000000000959
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  3. Article: Cardiac Adverse Events Following COVID-19 Vaccination in Patients With Prior Vaccine-Associated Myocarditis.

    Montgomery, Jay R / Hoffman, Donna L / Ryan, Margaret A / Lee, Rachel U / Housel, Laurie A / Engler, Renata J / Collins, Limone C / Atwood, John E / Cooper, Leslie T

    Federal practitioner : for the health care professionals of the VA, DoD, and PHS

    2023  Volume 40, Issue 1, Page(s) 6–10

    Abstract: Background: Limited information exists to guide shared clinical decision making on COVID-19 vaccination in persons with a prior history of vaccine-associated myocarditis, pericarditis, or myopericarditis (VAMP). The objective of this retrospective ... ...

    Abstract Background: Limited information exists to guide shared clinical decision making on COVID-19 vaccination in persons with a prior history of vaccine-associated myocarditis, pericarditis, or myopericarditis (VAMP). The objective of this retrospective observational case series was to characterize cardiac outcomes within 30 days following receipt of 1 or more COVID-19 vaccinations during 2021 in US service members diagnosed with prior non-COVID-19 VAMP between 1998 and 2019.
    Methods: As part of the collaborative public health mission with the Centers for Disease Control and Prevention for enhanced vaccine adverse events surveillance, the Defense Health Agency Immunization Healthcare Division maintains a clinical database of service members and beneficiaries referred for suspected adverse events following immunizations. Cases in this database recorded between January 1, 2003, and February 28, 2022, were reviewed to identify individuals with prior VAMP who received a COVID-19 vaccine in 2021 and developed signs or symptoms suggestive of VAMP within 30 days following COVID-19 vaccination.
    Results: Before the COVID-19 pandemic, 431 service members had verified VAMP. Among these 431 patients, 179 had records that confirmed receipt of a COVID-19 vaccine in 2021. Of these 179 patients, 171 (95.5%) were male. Their median age was 39 years (range, 21-67) at the time of COVID-19 vaccination. Most (n = 172; 96.1%) experienced their original VAMP episode after receipt of the live replicating smallpox vaccine. Eleven patients experienced cardiac-suggestive symptoms (chest pain, palpitations, or dyspnea) within 30 days of COVID-19 vaccination. Four patients met the criteria for recurrent VAMP. Three men aged 49, 50, and 55 years developed myocarditis within 3 days of an mRNA COVID-19 vaccine. One 25-year-old man developed pericarditis within 4 days of receiving an mRNA vaccine. All 4 COVID-19 recurrent VAMP cases fully recovered with minimal supportive care within weeks (myocarditis) to months (pericarditis).
    Conclusions: As demonstrated by this case series, albeit rare, VAMP may reoccur after COVID-19 vaccination among patients who experienced cardiac injury after smallpox vaccination. The clinical characteristics and course of the 4 recurring cases were mild, appearing similar to the post-COVID-19 VAMP described in individuals without a history of VAMP. More research is warranted on factors that may predispose patients to vaccine-associated cardiac injury and which vaccine platforms or schedules may reduce the risk of recurrence among patients who have experienced these events.
    Language English
    Publishing date 2023-01-17
    Publishing country United States
    Document type Journal Article
    ISSN 1078-4497
    ISSN 1078-4497
    DOI 10.12788/fp.0354
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  4. Article: The need for standardizing the aeroallergen immunotherapy missed-dose adjustment protocol.

    Montgomery, Jay R

    Allergy and asthma proceedings

    2008  Volume 29, Issue 4, Page(s) 425–426

    MeSH term(s) Administration, Intranasal ; Aerosols ; Allergens/administration & dosage ; Desensitization, Immunologic/standards ; Drug Administration Schedule ; Drug Dosage Calculations ; Humans ; Pilot Projects ; Practice Guidelines as Topic
    Chemical Substances Aerosols ; Allergens
    Language English
    Publishing date 2008-07
    Publishing country United States
    Document type Letter
    ZDB-ID 1312445-6
    ISSN 1088-5412
    ISSN 1088-5412
    DOI 10.2500/aap.2008.29.3142
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  5. Article ; Online: Treating SIRVA Early With Corticosteroid Injections: A Case Series.

    Macomb, Christopher V / Evans, Martin O / Dockstader, Jo E / Montgomery, Jay R / Beakes, Douglas E

    Military medicine

    2019  Volume 185, Issue 1-2, Page(s) e298–e300

    Abstract: Shoulder injury related to vaccine administration (SIRVA) is defined as "shoulder pain with limited range of motion within 48 hours after vaccine receipt in individuals with no prior history of pain, inflammation, or dysfunction of the affected shoulder ... ...

    Abstract Shoulder injury related to vaccine administration (SIRVA) is defined as "shoulder pain with limited range of motion within 48 hours after vaccine receipt in individuals with no prior history of pain, inflammation, or dysfunction of the affected shoulder before vaccine administration." Corticosteroid injections (CSIs) have been proposed as a reasonable treatment modality for SIRVA, although evidence regarding efficacy is scanty. In this case series, we present two patients diagnosed with SIRVA who received CSI within 5 days of symptom onset and saw symptom resolution within 1 month. This is in comparison to a Centers for Disease Control and Prevention report that showed 65% of patients with SIRVA will have pain lasting longer than 1 month, and 25% will have pain lasting longer than 3 months. Our case series shows that CSIs may be an effective treatment modality for SIRVA. It would be reasonable to use CSIs as a first line treatment and should especially be considered in patients who have contraindications to nonsteroidal anti-inflammatory drugs.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Humans ; Injections ; Shoulder Injuries ; Shoulder Pain ; Vaccination
    Chemical Substances Adrenal Cortex Hormones
    Language English
    Publishing date 2019-10-17
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usz269
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  6. Article ; Online: Myocarditis and pericarditis recovery following smallpox vaccine 2002-2016: A comparative observational cohort study in the military health system.

    Engler, Renata J M / Montgomery, Jay R / Spooner, Christina E / Nelson, Michael R / Collins, Limone C / Ryan, Margaret A / Chu, Clara S / Atwood, John E / Hulten, Edward A / Rutt, Ahlea A / Parish, Dacia O / McClenathan, Bruce M / Hrncir, David E / Duran, Laurie / Skerrett, Catherine / Housel, Laurie A / Brunader, Janet A / Ryder, Stephanie L / Lohsl, Connie L /
    Hemann, Brian A / Cooper, Leslie T

    PloS one

    2023  Volume 18, Issue 5, Page(s) e0283988

    Abstract: Objectives: (1) Characterize the initial clinical characteristics and long-term outcomes of smallpox vaccine-associated hypersensitivity myocarditis and pericarditis (MP) in United States service members. (2) Describe the process of case identification ... ...

    Abstract Objectives: (1) Characterize the initial clinical characteristics and long-term outcomes of smallpox vaccine-associated hypersensitivity myocarditis and pericarditis (MP) in United States service members. (2) Describe the process of case identification and adjudication using the 2003 CDC nationally defined myocarditis/pericarditis epidemiologic case definitions to include consideration of case-specific diversity and evolving evidence.
    Background: Between 2002 and 2016, 2.546 million service members received a smallpox Vaccinia vaccine. Acute MP is associated with vaccinia, but the long-term outcomes have not been studied.
    Methods: Records of vaccinia-associated MP reported to the Vaccine Adverse Event Reporting System by vaccination date were adjudicated using the 2003 MP epidemiologic case definitions for inclusion in a retrospective observational cohort study. Descriptive statistics of clinical characteristics, presentation, cardiac complications, and time course of clinical and cardiac recovery were calculated with comparisons by gender, diagnosis and time to recovery.
    Results: Out of over 5000 adverse event reports, 348 MP cases who survived the acute illness, including 276 myocarditis (99.6% probable/confirmed) and 72 pericarditis (29.2% probable/confirmed), were adjudicated for inclusion in the long-term follow-up. Demographics included a median age of 24 years (IQR 21,30) and male predominance (96%). Compared to background military population, the myocarditis and pericarditis cohort had a higher percentage of white males by 8.2% (95% CI: 5.6, 10.0) and age <40 years by 4.2% (95% CI: 1.7,5.8). Long-term follow-up documented full recovery in 267/306 (87.3%) with 74.9% recovered in less than a year (median ~3 months). Among patients with myocarditis, the percentage who had a delayed time to recovery at time of last follow-up was 12.8% (95% CI: 2.1,24.7) higher in those with an acute left ventricular ejection fraction (EF) of ≤50% and 13.5% (95% CI: 2.4,25.7) higher in those with hypokinesis. Patient complications included 6 ventricular arrhythmias (2 received implanted defibrillators) and 14 with atrial arrhythmias (2 received radiofrequency ablation). Three of 6 patients (50%) diagnosed with cardiomyopathy had clinical recovery at their last follow-up date.
    Conclusions: Hypersensitivity myocarditis/pericarditis following the smallpox vaccine is associated with full clinical and functional ventricular recovery in over 87% of cases (74.9% <1 year). A minority of MP cases experienced prolonged or incomplete recovery beyond 1 year.
    MeSH term(s) Humans ; Male ; United States ; Adult ; Female ; Smallpox Vaccine/adverse effects ; Myocarditis/epidemiology ; Myocarditis/etiology ; Myocarditis/diagnosis ; Vaccinia/prevention & control ; Retrospective Studies ; Military Health Services ; Stroke Volume ; Ventricular Function, Left ; Vaccination ; Pericarditis/epidemiology ; Pericarditis/etiology ; Pericarditis/diagnosis ; Smallpox/prevention & control ; Vaccinia virus
    Chemical Substances Smallpox Vaccine
    Language English
    Publishing date 2023-05-08
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0283988
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  7. Article ; Online: High-dose, rapid-infusion IVIG in postvaccination acute disseminated encephalomyelitis.

    Fu, Diana C / Montgomery, Jay R

    Neurology

    2008  Volume 71, Issue 4, Page(s) 294–295

    MeSH term(s) Adult ; Central Nervous System/immunology ; Central Nervous System/pathology ; Central Nervous System/physiopathology ; Cerebrospinal Fluid/cytology ; Disease Progression ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Encephalomyelitis, Acute Disseminated/chemically induced ; Encephalomyelitis, Acute Disseminated/drug therapy ; Encephalomyelitis, Acute Disseminated/immunology ; Glucocorticoids/administration & dosage ; Humans ; Immunoglobulins, Intravenous/administration & dosage ; Immunologic Factors/administration & dosage ; Immunosuppression/methods ; Immunotherapy/methods ; Magnetic Resonance Imaging ; Male ; Methylprednisolone Hemisuccinate/administration & dosage ; Military Personnel ; Physical Therapy Modalities ; Quadriplegia/chemically induced ; Quadriplegia/drug therapy ; Quadriplegia/immunology ; Recovery of Function/drug effects ; Recovery of Function/immunology ; Smallpox Vaccine/adverse effects ; Treatment Outcome ; Typhoid-Paratyphoid Vaccines/adverse effects ; Vaccines/adverse effects
    Chemical Substances Glucocorticoids ; Immunoglobulins, Intravenous ; Immunologic Factors ; Smallpox Vaccine ; Typhoid-Paratyphoid Vaccines ; Vaccines ; Methylprednisolone Hemisuccinate (5GMR90S4KN)
    Language English
    Publishing date 2008-07-22
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/01.wnl.0000318277.25679.9e
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  8. Article ; Online: Preemptive Tecovirimat Use in an Active Duty Service Member Who Presented With Acute Myeloid Leukemia After Smallpox Vaccination.

    Lindholm, David A / Fisher, Raymond D / Montgomery, Jay R / Davidson, Whitni / Yu, Patricia A / Yu, Yon C / Burgado, Jillybeth / Wilkins, Kimberly / Petersen, Brett W / Okulicz, Jason F

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2019  Volume 69, Issue 12, Page(s) 2205–2207

    Abstract: Smallpox vaccine is contraindicated in immunosuppression due to increased risk for adverse reactions (eg, progressive vaccinia). We describe the first-ever use of tecovirimat as a preemptive vaccinia virus treatment strategy during induction chemotherapy ...

    Abstract Smallpox vaccine is contraindicated in immunosuppression due to increased risk for adverse reactions (eg, progressive vaccinia). We describe the first-ever use of tecovirimat as a preemptive vaccinia virus treatment strategy during induction chemotherapy in an active duty service member who presented with acute leukemia and inadvertent autoinoculation after smallpox vaccination.
    MeSH term(s) Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Antiviral Agents/administration & dosage ; Benzamides/administration & dosage ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Isoindoles/administration & dosage ; Leukemia, Myeloid, Acute/diagnosis ; Leukemia, Myeloid, Acute/etiology ; Leukemia, Myeloid, Acute/therapy ; Male ; Military Personnel ; Premedication ; Smallpox/prevention & control ; Smallpox Vaccine/administration & dosage ; Smallpox Vaccine/adverse effects ; Smallpox Vaccine/immunology ; Symptom Assessment ; Treatment Outcome ; Vaccination/adverse effects ; Vaccination/methods ; Vaccinia virus/drug effects ; Vaccinia virus/immunology
    Chemical Substances Antiviral Agents ; Benzamides ; Immunoglobulins, Intravenous ; Isoindoles ; Smallpox Vaccine ; tecovirimat (F925RR824R)
    Language English
    Publishing date 2019-03-12
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciz286
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  9. Article: Ocular vaccinia: a consequence of unrecognized contact transmission.

    Montgomery, Jay R / Carroll, Robert B / McCollum, Andrea M

    Military medicine

    2011  Volume 176, Issue 6, Page(s) 699–701

    Abstract: A patient developed severe ocular vaccinia via autoinoculation after acquiring unrecognized contact-transmitted vaccinia from wrestling with vaccinated members of his unit. This case highlights both the need to reinforce infection-control measures among ... ...

    Abstract A patient developed severe ocular vaccinia via autoinoculation after acquiring unrecognized contact-transmitted vaccinia from wrestling with vaccinated members of his unit. This case highlights both the need to reinforce infection-control measures among vaccinees and the need for providers to be familiar with the identification and treatment of cutaneous and ocular vaccinia infection.
    MeSH term(s) Adult ; Antiviral Agents/therapeutic use ; Eye Infections, Viral/diagnosis ; Eye Infections, Viral/drug therapy ; Eye Infections, Viral/virology ; Humans ; Male ; Orthopoxvirus/isolation & purification ; Smallpox Vaccine/adverse effects ; Trifluridine/therapeutic use ; Vaccination/adverse effects ; Vaccinia/transmission ; Wrestling
    Chemical Substances Antiviral Agents ; Smallpox Vaccine ; Trifluridine (RMW9V5RW38)
    Language English
    Publishing date 2011-06-20
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.7205/milmed-d-10-00473
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  10. Article ; Online: Case report: Chest pain in service members following smallpox vaccination.

    Montgomery, Jay R / Engler, Renata / Allan-Martinez, Frances / Morse, Ann / Duran, Laurie

    MSMR

    2012  Volume 19, Issue 3, Page(s) 6–7

    MeSH term(s) Adult ; Chest Pain/chemically induced ; Chest Pain/diagnosis ; Chest Pain/etiology ; Humans ; Male ; Myocarditis/chemically induced ; Myocarditis/diagnosis ; Myocarditis/etiology ; Smallpox/prevention & control ; Smallpox Vaccine/adverse effects ; Vaccination/adverse effects ; Young Adult
    Chemical Substances Smallpox Vaccine
    Language English
    Publishing date 2012-03
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 2152-8217
    ISSN (online) 2152-8217
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