How Common Are Long-Lasting, Intensely Itching Vaccination Granulomas and Contact Allergy to Aluminium Induced by Currently Used Pediatric Vaccines? A Prospective Cohort Study

Eur J Pediatr. 2014 Oct;173(10):1297-307. doi: 10.1007/s00431-014-2318-2. Epub 2014 Apr 22.

Abstract

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Aluminum / adverse effects*
  • Child
  • Child, Preschool
  • Dermatitis, Allergic Contact / diagnosis
  • Dermatitis, Allergic Contact / epidemiology
  • Dermatitis, Allergic Contact / etiology*
  • Diphtheria-Tetanus-Pertussis Vaccine / adverse effects*
  • Diphtheria-Tetanus-Pertussis Vaccine / chemistry
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / adverse effects*
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / chemistry
  • Female
  • Follow-Up Studies
  • Granuloma / diagnosis
  • Granuloma / epidemiology
  • Granuloma / etiology*
  • Haemophilus Vaccines / adverse effects*
  • Haemophilus Vaccines / chemistry
  • Heptavalent Pneumococcal Conjugate Vaccine
  • Humans
  • Infant
  • Male
  • Pneumococcal Vaccines / adverse effects*
  • Pneumococcal Vaccines / chemistry
  • Poliovirus Vaccine, Inactivated / adverse effects*
  • Poliovirus Vaccine, Inactivated / chemistry
  • Prospective Studies
  • Pruritus / epidemiology
  • Pruritus / etiology*
  • Risk
  • Sweden
  • Vaccines, Combined / adverse effects
  • Vaccines, Combined / chemistry

Substances

  • Diphtheria-Tetanus-Pertussis Vaccine
  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Haemophilus Vaccines
  • Heptavalent Pneumococcal Conjugate Vaccine
  • Pentavac
  • Pneumococcal Vaccines
  • Poliovirus Vaccine, Inactivated
  • Vaccines, Combined
  • Aluminum