Vaccine-induced aluminium allergy and long-lasting subcutaneous itching nodules
Background: Aluminium contact dermatitis is rare even though aluminium is frequently used in antiperspirants and sunscreens. Sensitisation to aluminium is mostly a side effect of aluminium-adsorbed vaccines. These can also induce long-lasting intensely itching subcutaneous nodules (granulomas) at the injection site. During clinical trials on an acellular aluminium-adsorbed pertussis vaccine in the 1990s in Gothenburg, Sweden, persistent itching nodules were -unexpectedly- reported in 745 of ~ 76 000 vaccinated. Contact dermatitis to aluminium was verified by patch test in 377 children with itching nodules. Aim: This thesis aims to study the long-term clinical prognosis of itching subcutaneous nodules and aluminium allergy in children who received an aluminium-adsorbed pertussis vaccine in a clinical trial. Patients and Methods: All 745 vaccinated children with itching nodules in the pertussis vaccine trial were enrolled in a long-term follow-up study (>20 years). Results: The median duration of itching was 6.6 years. During the follow-up time 637/745 (86%) of the participants experienced full symptom recovery. The remaining were markedly improved. In 186 of 241 (77%) children who were tested twice, aluminium hypersensitisation was no longer detectable. A negative patch test was significantly correlated with loss of itching. 3-7% of the participants who received other aluminium-adsorbed vaccines later in life reported mild and transient itching at the new injection site. The optimal compound to establish aluminium hypersensitivity could not be determined. Conclusion and recommendations: Vaccine-induced subcutaneous itching nodules associated with aluminium allergy in infants and children can cause great suffering and have a protracted course. However, long-term prospective studies5 show that both clinical symptoms and delayed hypersensitivity for aluminium disappear over time. Further vaccination with aluminium-adsorbed vaccines is safe in older children given that the original nodule has vanished and the itching will have resolved or nearly resolved.
Parts of work
I. Gente Lidholm A, Bergfors E, Inerot A, Blomgren U, Gillstedt M, Trollfors B. Unexpected loss of contact allergy to aluminium induced by vaccine. Contact dermatitis. 2013;68(5):286-92. ::doi::10.1111/cod.12053II. Gente Lidholm A, Inerot A, Gillstedt M, Bergfors E, Trollfors B. Comparison of reactivity to a metallic disc and 2% aluminium salt in 366 children, and reproducibility over time for 241 young adults with childhood vaccine-related aluminium contact allergy. Contact Dermatitis 2018; Jul;79(1):26-30. ::doi::10.1111/cod.12977III. Gente Lidholm A, Inerot A, Gillstedt M, Bergfors E, Trollfors B. Long-term clinical course and prognosis of vaccine-related persistent itching nodules. Manuscript submitted for publication.IV. Gente Lidholm A, Inerot A, Gillstedt M, Bergfors E, Trollfors B. Long-term prognosis of vaccine-induced contact allergy to aluminium - third patch-test and different test preparations. In manuscript.
Doctor of Philosophy (Medicine)
University of Gothenburg. Sahlgrenska Academy
Institute of Clinical Sciences. Department of Dermatology and Venereology
Torsdagen den 2 december 2021, kl 9.00, Hörsal Arvid Carlsson, Academicum, Medicinaregatan 3, Göteborg
Date of defence
Gente Lidholm, Anette