Such reactions may appear as edema or inflammation at the injection site or cause a variety of manifestations elsewhere, such as redness of the skin, itching, conjunctivitis, rhinitis, swelling of the face (angioedema), the upper or (and) lower lip, cheeks, vocal cords, pharynx accompanied by difficulty of breathing or swallowing, urticaria, severe dyspnea, which may progress to anaphylactic shock.
Should there be a comma before "accompanied by"?
The Russian original uses "with" instead of "accompanied by", but I thought that might mean like "pharynx with difficulties of breathing", so I used "accompanied".
I think that if there was a full stop after "swallowing", a comma would have been okay; but with the list continuing, it might be better without one.