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Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines—prognosis and outcome after booster vaccination

European Journal of Pediatrics volume 172, pages 171–177 (2013)Cite this article

Abstract

Persistent itching subcutaneous nodules and aluminium (Al) allergy have been described after vaccination with Al-adsorbed vaccines but are considered rare. Little is known about the prognosis. Sixty-four children with itching nodules following vaccination with diphtheria–tetanus–pertussis (DTP) vaccines currently used in Sweden (Infanrix® and Pentavac®) were spontaneously reported to the authors from 1999 and followed for up to 12 years. The median duration of itching was 5 years in the 44 children who were free or almost free from symptoms at the latest follow-up. Typical findings were a long interval between vaccination and onset of symptoms (months or years) and intensified itching during intercurrent infections. Contact allergy to aluminium was demonstrated in 60/63 children (95 %). Neither the incidence nor differences between the two vaccines can be estimated from this study, but vaccine-induced itching nodules are probably more common than hitherto realised. The median interval between onset of symptoms and diagnosis was 8 months in a region where nurses were educated to recognise the condition compared to 2 years in other regions. Booster vaccination with DTP-polio was postponed or declined by 15/40 families in fear for new problems. Out of 25 children who received a booster dose, only two had new itching nodules. Conclusion: Intensely itching subcutaneous nodules (vaccination granulomas) and contact allergy to aluminium may occur after primary vaccination with the two most commonly used DTP vaccines in Europe. The condition is probably underreported. Symptoms may last for at least 4–5 years but eventually seem to subside.

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Acknowledgments

We thank Ulla Nyström-Kronander, MD, Allergy Center, University Hospital, Linköping and Lars Falk, PhD, Department of Dermatology and Venerology, Vrinnevisjukhuset, Norrköping for patch testing children in Östergötland and for valuable contribution to the manuscript. Financial support was obtained from the The Research and Development Units in Local Health Care in Södra Älvsborg and in Östergötland, The Research Board of Local Care Eastern Östergötland and by ALF grants from the County Council of Östergötland.

Conflict of interest

The authors declare that they have no financial relationship with the organisations which sponsored the research.

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Authors and Affiliations

  1. The Research and Development Unit in Local Health Care, County of Östergötland, St Larsgatan 9D, 58185, Linköping, Sweden

    Elisabet Bergfors

  2. Department of Paediatrics, Sahlgrenska University Hospital-East, 41685, Gothenburg, Sweden

    Birger Trollfors

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  1. Elisabet Bergfors
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Correspondence to Elisabet Bergfors.

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Bergfors, E., Trollfors, B. Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines—prognosis and outcome after booster vaccination. Eur J Pediatr 172, 171–177 (2013). https://doi.org/10.1007/s00431-012-1841-2

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  • DOI: https://doi.org/10.1007/s00431-012-1841-2

Keywords

  • Itching nodule
  • Granuloma
  • Contact allergy
  • Aluminium
  • Adjuvant
  • Vaccines