ABSTRACT
UNLABELLED: The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. CONCLUSION: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.
Subject(s)
Aluminum/adverse effects , Dermatitis, Allergic Contact/etiology , Diphtheria-Tetanus-Pertussis Vaccine/adverse effects , Diphtheria-Tetanus-acellular Pertussis Vaccines/adverse effects , Granuloma/etiology , Haemophilus Vaccines/adverse effects , Pneumococcal Vaccines/adverse effects , Poliovirus Vaccine, Inactivated/adverse effects , Pruritus/etiology , Adolescent , Child , Child, Preschool , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/epidemiology , Diphtheria-Tetanus-Pertussis Vaccine/chemistry , Diphtheria-Tetanus-acellular Pertussis Vaccines/chemistry , Female , Follow-Up Studies , Granuloma/diagnosis , Granuloma/epidemiology , Haemophilus Vaccines/chemistry , Heptavalent Pneumococcal Conjugate Vaccine , Humans , Infant , Male , Pneumococcal Vaccines/chemistry , Poliovirus Vaccine, Inactivated/chemistry , Prospective Studies , Pruritus/epidemiology , Risk , Sweden , Vaccines, Combined/adverse effects , Vaccines, Combined/chemistryABSTRACT
A 2-year-old girl presented with an intensely itching subcutaneous nodule on the front of a thigh. The nodule persisted for 10 months until it was excised. Subsequent investigation for malignancy and systemic disease showed no pathological findings. The diagnosis, persistent itching vaccination granuloma, was revealed by hazard almost 2 years after the onset of symptoms. Persistent itching subcutaneous nodules at the injection site for aluminium containing vaccines (mostly diphtheria-tetanus-pertussis combination vaccines for primary immunisation of infants) may appear with a long delay after the vaccination (months), cause prolonged itching (years) and are often associated with contact allergy to aluminium. The condition is poorly recognised in Health Care which may lead to prolonged symptoms and unnecessary investigations.
