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Raison-Peyron N, El Gana M, Amelot F, Bessis D. Post-vaccine nodules with prurigo in a child successfully treated by dupilumab. Pediatr Dermatol 2024. [PMID: 38697666 DOI: 10.1111/pde.15615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/24/2024] [Indexed: 05/05/2024]
Abstract
We report the case of a 7-year-old girl with severe generalized prurigo associated with diffuse persistent pruritic nodules due to sensitization to aluminum-adsorbed vaccines. Treatment with dupilumab resulted in an excellent therapeutic response.
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Affiliation(s)
- Nadia Raison-Peyron
- Department of Dermatology, University Hospital of Montpellier and University of Montpellier, Montpellier, France
| | - Marwa El Gana
- Department of Dermatology, University Hospital of Montpellier and University of Montpellier, Montpellier, France
| | | | - Didier Bessis
- Department of Dermatology, University Hospital of Montpellier and University of Montpellier, Montpellier, France
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2
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Hoffmann SS, Thiesson EM, Johansen JD, Hviid A. Association between atopic disease and vaccination granulomas: A nested case-control study. Contact Dermatitis 2024; 90:411-419. [PMID: 38059542 DOI: 10.1111/cod.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Vaccination granulomas are observed in 1% of all children vaccinated with an aluminium-adsorbed vaccine. Most children with granulomas also have aluminium contact allergy (CA). CA and atopic diseases are both highly prevalent among children and may be associated. OBJECTIVE To investigate the association between vaccination granulomas and atopic dermatitis (AD), asthma and rhinitis in children. METHODS We sourced a cohort of all Danish children born from 2009 to 2017 and conducted a nested case-control study, with cases defined as children with vaccination granulomas, matched to controls 1:10 on sex, socioeconomic class, gestational age and season of birth. All cases and controls were vaccinated with aluminium-adsorbed vaccines and followed until their second birthday. We used conditional logistic regression to estimate the odds ratios (ORs). RESULTS The study included 2171 cases with vaccination granulomas, and 21 710 controls. Children with a diagnosis of AD had a significantly higher risk of a vaccination granuloma (OR 1.50, 95% confidence intervals [CI] 1.25-1.80). No significant association was found between granulomas and asthma or rhinitis. The association between granulomas and AD was even higher in an additional sensitivity-analysis, following the children until their fourth birthday (OR 2.71, 95% CI 2.36-3.11). CONCLUSION AD was significantly associated with vaccination granulomas, but not with other atopic diseases, within both the first 2 and 4 years of life.
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Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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3
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Lidholm AG, Inerot A, Gillstedt M, Bergfors E, Trollfors B. Long-term prognosis of vaccine-induced contact allergy to aluminium: Third patch-test with additional test preparations. Contact Dermatitis 2023; 89:359-367. [PMID: 37548037 DOI: 10.1111/cod.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND A high incidence of local itching subcutaneous nodules and aluminium allergy was observed in clinical trials of a new aluminium adsorbed pertussis vaccine in Gothenburg, Sweden, in the 1990s. A total of 495 children with itching nodules were patch tested with aluminium chloride hexahydrate 2% and an empty Finn Chamber®, 377 (76%) with positive reactions. When 241 of them were re-tested some years later 186 (3 out of 4) had unexpectedly lost their patch test reactivity. AIM To investigate the long-term prognosis of vaccine-induced contact allergy to aluminium by a third patch test about 20 years after Patch test I. METHODS Twenty individuals with positive and 11 with negative results in Patch test II were tested a third time with the same sensitisers as in in the first two tests. Three additional aluminium preparations were also tested. RESULTS A total 15 out of 20 persons with positive results in the second test had lost their patch test reactivity. Two of 11 with negative tests had turned positive again. The addition of the preparations gave no conclusive results. CONCLUSION Contact allergy to aluminium caused by vaccination with aluminium-adsorbed vaccines in childhood seems to fade away with time as measured by loss of patch test reactivity.
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Affiliation(s)
- Anette Gente Lidholm
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annica Inerot
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Bergfors
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birger Trollfors
- Department of Paediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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4
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Lidholm AG, Inerot A, Gillstedt M, Bergfors E, Trollfors B. Long-term clinical course and prognosis of vaccine-related persistent itching nodules (1997-2019): An observational study. Vaccine X 2022; 11:100163. [PMID: 35600985 PMCID: PMC9118174 DOI: 10.1016/j.jvacx.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/09/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccine-induced itching nodules almost always resolve over time. The symptoms may last up to six years though diminishing with time. Contact allergy to aluminium is not a cause to refrain from further vaccination. Vaccination can continue once the nodule has vanished and the itching has resolved.
Background Vaccines adsorbed to aluminium can induce long-lasting intensely itching subcutaneous nodules (granulomas) at the injection site as well as contact allergy to aluminium. In clinical trials of a new acellular pertussis vaccine performed in the 1990s (Gothenburg, Sweden) with 76 000 participants, itching nodules were reported in 745 children. A positive patch test to aluminium was verified in 77% of the tested children with itchy nodules. Aim To describe the long-term clinical course and prognosis of vaccine-related itching nodules caused by aluminium-containing pediatric vaccines and to estimate the risk for new symptoms after future vaccination with aluminium-containing vaccines. Methods 745 children with vaccine-related itching nodules were followed by regular interviews/questionnaires for more than 20 years. 723 of them received a booster dose of diphtheria/tetanus vaccine either with or without aluminium adjuvant during the follow-up time. Results Most study participants (86%) reported a full recovery from their itching nodules after a median duration of 6.6 years. Only a few of the diphtheria/tetanus-booster-vaccinated children (3%) reported mild transient itching and swelling at the new injection site. Conclusion Vaccine-induced itching granulomas caused by an aluminium-adsorbed acellular pertussis toxoid vaccine seem to disappear over time. Future vaccinations with aluminium-adsorbed vaccines can be performed with little risk for new itching nodules later in life.
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Affiliation(s)
- Anette Gente Lidholm
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annica Inerot
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Bergfors
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birger Trollfors
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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5
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Skovbo Hoffmann S, Thiesson EM, Johansen JD, Hviid A. Risk factors for granulomas in children following immunisation with aluminium adsorbed vaccines: A Danish population-based cohort study. Contact Dermatitis 2022; 87:430-438. [PMID: 35778959 DOI: 10.1111/cod.14180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aluminium adsorbed vaccines may in some children cause severely itching nodules at the injection site, known as vaccination granulomas. OBJECTIVE To investigate vaccine-, child- and maternal level risk factors for the development of vaccination granulomas following immunisation with aluminium adsorbed vaccines. METHODS A Danish population-based cohort study with 553 932 children born in Denmark from 1 January 2009 to 31 December 2018, vaccinated with an aluminium adsorbed vaccine during the first year of life, followed until 31 December 2020. Poisson regression was used to estimate granuloma rate ratios according to type of adjuvant, accumulated dose of aluminium, timing of vaccination appointments, sex, gestational age, having siblings with granulomas, maternal age, and maternal ethnicity. RESULTS We identified 1 901 vaccination granuloma cases (absolute risk, 0.34%). Among vaccine level factors, revaccination (third vs first vaccination appointment, adjusted rate ratio [RR] 1.26, 95% confidence interval [CI] 1.03-1.55), the specific adjuvant used (aluminium phosphate vs hydroxide, RR 0.58, 95% CI 0.48-0.70) and dosage (≥1.0 mg vs <1.0 mg, RR 1.34, 95% CI 1.19-1.52) were associated with risk of granulomas; the timing of vaccination appointments was not. Among child level factors, female sex (vs males, RR 1.12, 95% CI, 1.02-1.22), prematurity (vs term birth, RR 0.71, 95% CI, 0.54-0.93) and having sibling(s) with granulomas (vs no siblings with granulomas, RR 46.15, 95% CI, 33.67-63.26) were associated with risk of granulomas. Among maternal level factors, non-Danish ethnicity (vs. Danish, RR 0.51, 95% CI, 0.42-0.63) and young maternal age (<20 yrs. vs 20-39 yrs., RR 0.46, 95% CI 0.25-0.83) were associated with risk of granulomas. CONCLUSIONS Several risk factors for vaccination granulomas at both the vaccine, child, and maternal level, was identified. Reducing the dose of aluminium or replacing aluminium hydroxide with aluminium phosphate could reduce the risk of granulomas. However, this must be balanced against the potential for reduced immunogenicity.
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Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | | | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Pharmacovigilance Research Centre, Department of Drug Design and Pharmacology, University of Copenhagen, Denmark
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6
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Collinson AC, Moore L, Cheung A, Gold MS, Goh DW. Subcutaneous nodules following vaccination. J Paediatr Child Health 2022; 58:388-391. [PMID: 35137488 DOI: 10.1111/jpc.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/26/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Five patients presented to surgical clinics at our institution with subcutaneous nodules of the upper arm or thigh present for 6-18 months. Excisional or fine-needle biopsy was performed due to diagnostic uncertainty and parental concern. Histopathological examination revealed these to be cutaneous lymphoid hyperplasia in reaction to vaccine components. Nodular reactions with this histopathological pattern are well recognised within vaccine-related literature, but less commonly recognised in patients presenting to general paediatric or surgical clinics. This article reviews literature on delayed-onset nodule formation after vaccination and recommends observation and reassurance as mainstays of management of this largely benign entity.
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Affiliation(s)
- Anne C Collinson
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lynette Moore
- Department of Anatomical Pathology, SA Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Abigail Cheung
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael S Gold
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Day Way Goh
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Abstract
ABSTRACT Exposure to elemental aluminum and its salts is unavoidable. Aluminum as a metal is present in transport, construction, packaging, and electronic equipment. Aluminum salts are present in consumer products, food items and drinking water, vaccines, drugs, and antiperspirants. Aluminum in vaccines and preparations for allergen-specific immunotherapy are the major sensitization sources. The predominent clinical manifestations of aluminum allergy are pruritic subcutaneous nodules and eczematous dermatitis. Patch testing shall be performed with aluminum chloride hexahydrate (ACH) in petrolatum. The preparation with ACH 10% detects substantially more aluminum allergy than ACH 2%. A patch test with elemental aluminum, for example, an empty Finn Chamber, is only positive when there is a strong aluminum allergy. A patch test reading should be performed 1 week after the application so as not to miss 15% to 20% of aluminum allergy. Aluminum should be included in any baseline patch test series for children and investigated for a possible inclusion in baseline series for adults. Aluminum test chambers can interfere with the testing resulting in both false-negative and false-positive patch test reactions to nonaluminum contact sensitizers.
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8
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Des Roches A, Graham F, Begin P, Paradis L, Gold M. Evaluation of Adverse Reactions to Vaccines. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3584-3597. [PMID: 34627533 DOI: 10.1016/j.jaip.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/05/2023]
Abstract
The development and widespread use of vaccination over the past centuries has been the single most impactful intervention in public health, by effectively preventing morbidity and mortality from infectious diseases. Vaccination is generally well tolerated in the vast majority of the population, and the benefits of vaccination largely outweigh the risk of severe adverse events in the majority of patients. Vaccine hesitancy can be a significant concern and lead to infectious disease outbreaks. All health care providers play an important role in maintaining public confidence in vaccines because their attitude and knowledge is often critical in facilitating acceptance of a vaccine. The purpose of this review is to first, provide an understanding of the basic concepts that are relevant to vaccine pharmacovigilance, and secondly, to provide an overview and discuss management of both immune and nonimmune adverse events after vaccination.
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Affiliation(s)
- Anne Des Roches
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.
| | - François Graham
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Philippe Begin
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Louis Paradis
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Michael Gold
- Discipline of Pediatrics, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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9
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Hoffmann SS, Elberling J, Thyssen JP, Hansen KS, Johansen JD. Does aluminium in sunscreens cause dermatitis in children with aluminium contact allergy: A repeated open application test study. Contact Dermatitis 2021; 86:9-14. [PMID: 34536036 DOI: 10.1111/cod.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents report that children with aluminium contact allergy and vaccination granulomas may react to aluminium-containing sunscreen following application. OBJECTIVES To evaluate whether contact dermatitis develops following repeated application of aluminium-containing sunscreens in children with aluminium sensitization and vaccination granulomas. METHODS Sixteen children aged 2-9 years (mean age 5 years) with vaccination granulomas and a positive patch test reaction to aluminium chloride hexahydrate 2%/10% petrolatum completed a blinded repeated open application test (ROAT) with two daily applications of two sunscreens for 14 days. One cream contained aluminium and the other did not. The children served as their own controls. RESULTS Sixteen children completed the study. Only one child (6%) had a positive skin reaction during ROAT on day 2 to the sunscreen with aluminium. None reacted to the sunscreen without aluminium. CONCLUSIONS Use of aluminium-containing sunscreens may on a case basis lead to allergic contact dermatitis in aluminium allergic children.
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Affiliation(s)
- Stine S Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Kirsten S Hansen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,The Pediatric Department, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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10
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Mulholland D, Joyce EA, Foran A, Snow A. The Evaluation of Palpable Thigh Nodularity in Vaccination-age Children - Differentiating Vaccination Granulomas from Other Causes. J Med Ultrasound 2021; 29:129-131. [PMID: 34377647 PMCID: PMC8330674 DOI: 10.4103/jmu.jmu_51_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/18/2020] [Accepted: 07/07/2020] [Indexed: 11/22/2022] Open
Abstract
Palpable thigh nodularity is a relatively frequent indication for imaging of vaccination-age children, with patients often referred by their community physician or general practitioner. Ultrasound (US) is the imaging modality of choice to delineate the abnormality, and we present a number of characteristic findings that permit the radiologist and pediatrician to accurately identify the cause. A retrospective review was performed at the largest children's hospital in a European country between 2015 and 2017 over a 30-month period. A search was performed of the hospital's Picture Archiving and Communication System (PACS) for all children referred for a soft-tissue, upper limb, or lower limb US between January 2015 and July 2017. The findings were collated and stored in a spreadsheet. Nine patients were identified who developed subcutaneous nodules in the thigh at some point during their childhood vaccination schedule. Three of these patients had clinical histories strongly suggestive of a diagnosis of abscess or foreign body. The remaining six patients were selected for more in-depth analysis. Four of these patients had US features consistent with vaccination granuloma. Two patients were ultimately diagnosed with venolymphatic malformations. Palpable thigh nodularity in a child of vaccination age is encountered with a reasonable frequency. When encountered, granulomas tend to be located within the subcutaneous tissues, and we postulate that this is due to erroneous administration of a vaccine into the subcutis rather than into the muscle.
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Affiliation(s)
| | - Eimear A Joyce
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Ann Foran
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Aisling Snow
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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11
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Mistry BD, DeKoven JG. Widespread cutaneous eruption after aluminum-containing vaccination: A case report and review of current literature. Pediatr Dermatol 2021; 38:872-874. [PMID: 33931889 DOI: 10.1111/pde.14613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aluminum salts are adjuvants found in many vaccines. Although rare, patients have reported cutaneous reactions to aluminum salts including persistent pruritic subcutaneous nodules at the injection site. We report the case of an 11-year-old male who at the age of 5 years developed a generalized pruritic cutaneous eruption after receiving the aluminum-containing Quadracel® vaccination. Patch testing at that time was positive to aluminum salts and again on repeat patch testing 6 years later. Our case highlights a delayed systemic cutaneous reaction to a vaccine containing aluminum salts. We review cutaneous allergic reactions to vaccines containing aluminum salts and vaccination advice for patients with aluminum contact allergy.
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Affiliation(s)
- Bhavik D Mistry
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada
| | - Joel G DeKoven
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada
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12
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Hoffmann SS, Wennervaldt M, Alinaghi F, Simonsen AB, Johansen JD. Aluminium contact allergy without vaccination granulomas: A systematic review and meta-analysis. Contact Dermatitis 2021; 85:129-135. [PMID: 33797096 DOI: 10.1111/cod.13852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
Aluminium contact allergy is mainly seen as granulomas following immunization with aluminium-adsorbed vaccines and contact allergy following epicutaneous exposure may be overlooked. To investigate the prevalence of aluminium allergy confirmed by patch testing, with no association with vaccination granulomas, and explore whether epicutaneous exposure to aluminium can contribute to allergic contact dermatitis. Two authors independently searched PubMed and MEDLINE (OVID) for case studies on contact allergy to aluminium proven by patch testing. Age-stratified meta-analyses to calculate the pooled prevalence were performed. Twenty-five studies describing a total of 73 cases were included in the review. Seven studies were suitable for meta-analyses. The prevalence of aluminium contact allergy was 5.61% (95% confidence interval [CI] 0.12%-11.08%) for children and 0.36% (95% CI 0.04%-0.67%) for adults. The studies described a variety of epicutaneous exposures, where metallic aluminium, topical medicaments, and deodorants were the main sources. Aluminium sensitization without a known exposure source was described in 10 of the 25 articles. The prevalence of aluminium contact allergy in the general public may be higher than expected and not solely related to vaccination granulomas. However, the clinical relevance is rare if not related to granulomas.
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Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Michael Wennervaldt
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Farzad Alinaghi
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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13
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Clinical Features of Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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14
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Trollfors B. Itching nodules and aluminium allergy following vaccination with aluminium-adsorbed vaccines-Not a negligible problem. Acta Paediatr 2020; 109:2444-2445. [PMID: 32776543 DOI: 10.1111/apa.15487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Birger Trollfors
- Department of Paediatrics Sahlgrenska University Hospital Gothenburg Sweden
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15
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16
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Abstract
Subcutaneous vaccine (SC) administration is an outmoded practice which complicates vaccine administration recommendations. Local adverse events following immunization (AEFIs) are a recognized determinant of vaccine hesitancy/refusal which can lead to an increased prevalence of vaccine-preventable disease. This extensive narrative review provides high-grade evidence that intramuscular (IM) administration of all vaccine types [adjuvanted, live virus and non-adjuvanted (inactivated whole cell, split cell and subunit)] significantly reduces the likelihood of local adverse events. This, combined with moderate grade evidence that IM injection generates significantly greater immune response compared with SC injection, allows a strong recommendation to be made for the IM injection of all vaccines except BCG and Rotavirus. This will simplify vaccination practice, minimize the inadvertent misadministration of vaccines and potentially improve public trust in vaccination.
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Affiliation(s)
- Ian F Cook
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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17
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Sarti L, Lezmi G, Mori F, Giovannini M, Caubet JC. Diagnosis and management of hypersensitivity reactions to vaccines. Expert Rev Clin Immunol 2020; 16:883-896. [PMID: 32838592 DOI: 10.1080/1744666x.2020.1814745] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many countries in Europe now recommend and enforce mandatory vaccinations to improve vaccination coverage. Thus, the number of adverse events following immunization (AEFI) may show an increase. Among these events, severe hypersensitivity reactions to vaccines are rare. However, it is important that they be identified and recognized so that they may be adequately managed. AREAS COVERED The literature search was undertaken through PubMed and Embase to identify English-language papers focusing on hypersensitivity to vaccines. EXPERT OPINION Hypersensitivity reactions following vaccinations are rare and are classified according to their chronology and extension: immediate when they occur within the first 4 hours following administration and non-immediate when they occur later. Local reactions are the most common adverse event following injection of vaccines and generally do not require any allergy workup. Immediate reactions, however, are potentially IgE-mediated and require an allergy workup. In general, a previously known food allergy (i.e., egg or milk) is not a contraindication to immunizations. Patients with a known allergy to gelatin, yeast, latex, antibiotics, or other specific components of vaccines require an allergy workup before administration of the vaccine.
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Affiliation(s)
- Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital , Florence, Italy
| | - Guillaume Lezmi
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Necker-Enfants Malades , Paris, France.,Faculty of Medicine, Université Paris Descartes , Paris, France
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital , Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital , Florence, Italy
| | - Jean-Christoph Caubet
- Division of Pediatric Allergy, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
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18
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Bruze M, Mowitz M, Netterlid E, Siemund I, Svedman C. Patch testing with aluminum chloride hexahydrate in petrolatum. Contact Dermatitis 2020; 83:176-177. [DOI: 10.1111/cod.13571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Magnus Bruze
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Eva Netterlid
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Ingrid Siemund
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental DermatologyLund University, Skåne University Hospital Mamö Sweden
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19
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Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, Arzt-Gradwohl L, Barber D, Bazire R, Cavkaytar O, Comberiati P, Dramburg S, Durham SR, Eifan AO, Forchert L, Halken S, Kirtland M, Kucuksezer UC, Layhadi JA, Matricardi PM, Muraro A, Ozdemir C, Pajno GB, Pfaar O, Potapova E, Riggioni C, Roberts G, Rodríguez Del Río P, Shamji MH, Sturm GJ, Vazquez-Ortiz M. EAACI Allergen Immunotherapy User's Guide. Pediatr Allergy Immunol 2020; 31 Suppl 25:1-101. [PMID: 32436290 PMCID: PMC7317851 DOI: 10.1111/pai.13189] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Allergen immunotherapy is a cornerstone in the treatment of allergic children. The clinical efficiency relies on a well-defined immunologic mechanism promoting regulatory T cells and downplaying the immune response induced by allergens. Clinical indications have been well documented for respiratory allergy in the presence of rhinitis and/or allergic asthma, to pollens and dust mites. Patients who have had an anaphylactic reaction to hymenoptera venom are also good candidates for allergen immunotherapy. Administration of allergen is currently mostly either by subcutaneous injections or by sublingual administration. Both methods have been extensively studied and have pros and cons. Specifically in children, the choice of the method of administration according to the patient's profile is important. Although allergen immunotherapy is widely used, there is a need for improvement. More particularly, biomarkers for prediction of the success of the treatments are needed. The strength and efficiency of the immune response may also be boosted by the use of better adjuvants. Finally, novel formulations might be more efficient and might improve the patient's adherence to the treatment. This user's guide reviews current knowledge and aims to provide clinical guidance to healthcare professionals taking care of children undergoing allergen immunotherapy.
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Affiliation(s)
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cherry Alviani
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elisabeth Angier
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Stefania Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Lisa Arzt-Gradwohl
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Domingo Barber
- School of Medicine, Institute for Applied Molecular Medicine (IMMA), Universidad CEU San Pablo, Madrid, Spain.,RETIC ARADYAL RD16/0006/0015, Instituto de Salud Carlos III, Madrid, Spain
| | - Raphaëlle Bazire
- Allergy Department, Hospital Infantil Niño Jesús, ARADyAL RD16/0006/0026, Madrid, Spain
| | - Ozlem Cavkaytar
- Department of Paediatric Allergy and Immunology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Pasquale Comberiati
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Stephen R Durham
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Aarif O Eifan
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospitals NHS Foundation Trust, London, UK
| | - Leandra Forchert
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Max Kirtland
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Umut C Kucuksezer
- Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul University, Istanbul, Turkey
| | - Janice A Layhadi
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.,Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Antonella Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Women and Child Health, University of Padua, Padua, Italy
| | - Cevdet Ozdemir
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey.,Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Istanbul University, Istanbul, Turkey
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ekaterina Potapova
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Carmen Riggioni
- Pediatric Allergy and Clinical Immunology Service, Institut de Reserca Sant Joan de Deú, Barcelona, Spain
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Allergy and Respiratory Medicine (MP803), Clinical & Experimental Sciences & Human Development in Health Academic Units University of Southampton Faculty of Medicine & University Hospital Southampton, Southampton, UK
| | | | - Mohamed H Shamji
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.,the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Gunter J Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
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20
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Hoffmann SS, Thyssen JP, Elberling J, Hansen KS, Johansen JD. Children with vaccination granulomas and aluminum contact allergy: Evaluation of predispositions, avoidance behavior, and quality of life. Contact Dermatitis 2020; 83:99-107. [DOI: 10.1111/cod.13538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Stine S. Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Jacob P. Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Kirsten S. Hansen
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
- The Pediatric Department, Herlev and Gentofte HospitalUniversity of Copenhagen Herlev Denmark
| | - Jeanne D. Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
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21
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Silcock R, Crawford NW, Selvaraj G, McMinn A, Danchin M, Lazzaro T, Perrett KP. Subcutaneous nodules following immunization in children; in Victoria, Australia from 2007 to 2016. Vaccine 2020; 38:3169-3177. [PMID: 32147295 DOI: 10.1016/j.vaccine.2019.12.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/29/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Subcutaneous nodules are a rare adverse event following immunization (AEFI). We aimed to describe nodules at the injection site reported to SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community) using the Brighton Collaboration Case Definition (BCCD), management and recurrence following subsequent immunizations. METHOD We assessed 58 cases (<18 years of age) of 'nodule at injection site' reported to SAEFVIC, Melbourne, Australia, between May 2007 and June 2016. Case details were analyzed from records and phone interview follow-up. The Australian Immunization Registry was reviewed for immunization status. RESULTS 71% (41/58 reported cases) were consistent with the BCCD for subcutaneous nodule, 14% (8 cases) were 'possible subcutaneous nodules', 10% (6 cases) were nodules associated with BCG immunization and 5% (3 cases) were attributable to an alternative diagnosis. The median age at immunization was 12 months, (range 1 month-12 years); 54% male (22/41 cases). 17% (7 cases) had multiple nodules. Nodules were associated with immunizations containing aluminum (74%, 36/49 nodules), no aluminum (8%, 4 nodules) and unknown (18%, 9 nodules). Most cases developed symptoms within 3 days post-immunization (59%, 24 cases) and in the thigh (59%, 29 nodules). Pruritus was associated in 41% (17 cases). Around 1/3 (34%) of nodules resolved 6 months post immunization, 2/3 (68%) by 12 months, however 1/4 (24%) remained persistent for >24 months. 5 cases had prior nodules and 1 case had recurrence with subsequent immunization. 83% (34 cases) were fully immunized for age at follow-up. CONCLUSION Subcutaneous nodules at the injection site may occur following a wide range of vaccines, including vaccines without aluminum. All cases require careful review and where possible, specialist management and to support subsequent immunizations.
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Affiliation(s)
- Rowena Silcock
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), Murdoch Children's Research Institute, Melbourne, Australia.
| | - Nigel W Crawford
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), Murdoch Children's Research Institute, Melbourne, Australia.
| | - Gowri Selvaraj
- SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), Murdoch Children's Research Institute, Melbourne, Australia.
| | - Alissa McMinn
- SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), Murdoch Children's Research Institute, Melbourne, Australia.
| | - Margie Danchin
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Vaccine and Immunisation Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Teresa Lazzaro
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
| | - Kirsten P Perrett
- Population Allergy Research Group and Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Melbourne, Australia; Department of Allergy and Immunology and General Medicine, Royal Children's Hospital, Melbourne, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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22
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Raffi J, Suresh R, Botto N, Murase JE. The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: A retrospective chart review. J Am Acad Dermatol 2020; 82:132-138. [DOI: 10.1016/j.jaad.2019.09.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/01/2019] [Accepted: 09/14/2019] [Indexed: 12/23/2022]
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23
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Stone CA, Rukasin CR, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol 2019; 85:2694-2706. [PMID: 31472022 PMCID: PMC6955412 DOI: 10.1111/bcp.14112] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
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Affiliation(s)
- Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Christine R.F. Rukasin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | | | - Elizabeth J. Phillips
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt University Medical SchoolNashvilleTennessee
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24
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Inerot A, Bergfors E, Trollfors B. Response to: Patch test reactivity to aluminium chambers. Contact Dermatitis 2019; 82:135. [PMID: 31697406 DOI: 10.1111/cod.13433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Annica Inerot
- Clinical Sciences, Dermatology and Venereology, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Bergfors
- Public Health and Community Medicine, Unit of Family Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Birger Trollfors
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Bergfors E, Inerot A, Falk L, Nyström U, Trollfors B. Patch testing children with aluminium chloride hexahydrate in petrolatum: A review and a recommendation. Contact Dermatitis 2019; 81:81-88. [DOI: 10.1111/cod.13303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Elisabet Bergfors
- Department of Public Health and Community Medicine, Unit of Family MedicineInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg Göteborg Sweden
| | - Annica Inerot
- Department of Dermatology and VenereologyInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Sahlgrenska Academy Göteborg Sweden
| | - Lars Falk
- Department of Dermatology and VenereologyCounty Council of Östergötland Linköping Sweden
- Department of Clinical and Experimental MedicineLinköping University Linköping Sweden
| | - Ulla Nyström
- Allergy CentreLinköping University Hospital Linköping Sweden
| | - Birger Trollfors
- Department of PediatricsSahlgrenska University Hospital Göteborg Sweden
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26
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Silcock R, Crawford NW, Perrett KP. Subcutaneous nodules: an important adverse event following immunization. Expert Rev Vaccines 2019; 18:405-410. [DOI: 10.1080/14760584.2019.1586540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rowena Silcock
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
- SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), Murdoch Children’s Research Institute, Melbourne, Australia
| | - Nigel W Crawford
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
- SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), Murdoch Children’s Research Institute, Melbourne, Australia
| | - Kirsten P Perrett
- Population Allergy Research Group and Melbourne Children’s Trial Centre, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Allergy and Immunology and General Medicine, Royal Children’s Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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27
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Veien NK. Clinical Features of Contact Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_15-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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28
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Hsu CW, Weng CH, Chan MJ, Lin-Tan DT, Yen TH, Huang WH. Association Between Serum Aluminum Level and Uremic Pruritus in Hemodialysis Patients. Sci Rep 2018; 8:17251. [PMID: 30467375 PMCID: PMC6250692 DOI: 10.1038/s41598-018-35217-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/31/2018] [Indexed: 12/17/2022] Open
Abstract
Uremic pruritus (UP) is a common symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is complex. Aluminum (Al) is a common metal and is toxic to patients undergoing HD. Al is also a known human allergen which can induce immune reactions. However, the correlation between Al and UP remains unclear in dialysis patients. A total of 866 patients on maintenance HD were enrolled for analysis. The HD patients with higher serum Al levels had higher a prevalence of UP than those with lower serum Al levels. After adjusting for confounding variables, the serum Al level was significantly associated with UP. Overall, each 10-fold increase in serum Al level was associated with a 5.64-fold increase in the risk of developing UP in these subjects. The results of this cross-sectional study suggest that serum Al level may be associated with the development of UP in patients on maintenance HD.
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Affiliation(s)
- Ching-Wei Hsu
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Jen Chan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
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29
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Cabral-Miranda G, M Salman A, O Mohsen M, L Storni F, S Roesti E, A Skinner M, D Heath M, F Kramer M, M Khan S, J Janse C, V S Hill A, F Bachmann M. DOPS Adjuvant Confers Enhanced Protection against Malaria for VLP-TRAP Based Vaccines. Diseases 2018; 6:diseases6040107. [PMID: 30469323 PMCID: PMC6313579 DOI: 10.3390/diseases6040107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 12/25/2022] Open
Abstract
Vaccination remains the most effective and essential prophylactic tool against infectious diseases. Enormous efforts have been made to develop effective vaccines against malaria but successes remain so far limited. Novel adjuvants may offer a significant advantage in the development of malaria vaccines, in particular if combined with inherently immunogenic platforms, such as virus-like particles (VLP). Dioleoyl phosphatidylserine (DOPS), which is expressed on the outer surface of apoptotic cells, represents a novel adjuvant candidate that may confer significant advantage over existing adjuvants, such as alum. In the current study we assessed the potential of DOPS to serve as an adjuvant in the development of a vaccine against malaria either alone or combined with VLP using Plasmodium falciparum thrombospondin-related adhesive protein (TRAP) as a target antigen. TRAP was chemically coupled to VLPs derived from the cucumber mosaic virus fused to a universal T cell epitope of tetanus toxin (CuMVtt). Mice were immunized with TRAP alone or formulated in alum or DOPS and compared to TRAP coupled to CuMVtt formulated in PBS or DOPS. Induced immune responses, in particular T cell responses, were assessed as the major protective effector cell population induced by TRAP. The protective capacity of the various formulations was assessed using a transgenic Plasmodium berghei expressing PfTRAP. All vaccine formulations using adjuvants and/or VLP increased humoral and T cell immunogenicity for PfTRAP compared to the antigen alone. Display on VLPs, in particular if formulated with DOPS, induced the strongest and most protective immune response. Thus, the combination of VLP with DOPS may harness properties of both immunogenic components and optimally enhance induction of protective immune responses.
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Affiliation(s)
- Gustavo Cabral-Miranda
- The Jenner Institute, Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), Roosevelt Drive, Oxford OX3 7BN, UK.
- Department of Immunology, RIA, Inselspital, University of Bern, Sahlihaus 1/2, 3010 Bern, Switzerland.
| | - Ahmed M Salman
- The Jenner Institute, Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), Roosevelt Drive, Oxford OX3 7BN, UK.
| | - Mona O Mohsen
- The Jenner Institute, Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), Roosevelt Drive, Oxford OX3 7BN, UK.
| | - Federico L Storni
- Department of Immunology, RIA, Inselspital, University of Bern, Sahlihaus 1/2, 3010 Bern, Switzerland.
| | - Elisa S Roesti
- Department of Immunology, RIA, Inselspital, University of Bern, Sahlihaus 1/2, 3010 Bern, Switzerland.
| | | | - Matthew D Heath
- Bencard Adjuvant Systems, Dominion Way, Worthing BN14 8SA, UK.
| | | | - Shahid M Khan
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Chris J Janse
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Adrian V S Hill
- The Jenner Institute, Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), Roosevelt Drive, Oxford OX3 7BN, UK.
| | - Martin F Bachmann
- The Jenner Institute, Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), Roosevelt Drive, Oxford OX3 7BN, UK.
- Department of Immunology, RIA, Inselspital, University of Bern, Sahlihaus 1/2, 3010 Bern, Switzerland.
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30
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Gláucia-Silva F, Torres-Rêgo M, Rocha Soares KS, Damasceno IZ, Tambourgi DV, Silva-Júnior AAD, Fernandes-Pedrosa MDF. A biotechnological approach to immunotherapy: Antivenom against Crotalus durissus cascavella snake venom produced from biodegradable nanoparticles. Int J Biol Macromol 2018; 120:1917-1924. [PMID: 30287370 DOI: 10.1016/j.ijbiomac.2018.09.203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/20/2018] [Accepted: 09/28/2018] [Indexed: 12/22/2022]
Abstract
Snakebite envenoming is a tropical disease neglected worldwide. In Brazil, the Crotalus durissus cascavella (CDC) snake belongs to a genus with venom of highest lethality. A search for new immunoadjuvants aimed to expand the therapeutic alternatives to improve vaccines and antivenom. This approach proposed to produce small and narrow-sized cationic CDC venom-loaded chitosan nanoparticles (CHNP) able to induce antibody response against the CDC venom. The ionic gelation method induced the formation of stable and slightly smooth spherical nanoparticles (<160 nm) with protein loading efficiency superior to 90%. The interactions between venom proteins and CHNP assessed using FT-IR spectroscopy corroborated with the in vitro release behavior of proteins from nanoparticles. Finally, the immunization animal model using BALB/c mice demonstrated the higher effectiveness of CDC venom-loaded CHNP compared to aluminum hydroxide, a conventional immunoadjuvant. Thus, CHNPs loaded with CDC venom exhibited a promising biotechnological approach to immunotherapy.
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Affiliation(s)
- Fiamma Gláucia-Silva
- Graduate Program on Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Manoela Torres-Rêgo
- Graduate Program on Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Karla Samara Rocha Soares
- Graduate Program on Biochemistry, Bioscience Center, University Campus, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Lagoa Nova, 59072-970 Natal, Brazil.
| | - Igor Zumba Damasceno
- Department of Materials Engineering, Technology Center, University Campus, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Lagoa Nova, 59078-970 Natal, Brazil.
| | - Denise Vilarinho Tambourgi
- Laboratory of Immunochemistry, Instituto Butantan, Avenida Vital Brasil, 1500, Instituto Butantan, São Paulo 05503-000, Brazil.
| | - Arnóbio Antônio da Silva-Júnior
- Graduate Program on Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil.
| | - Matheus de Freitas Fernandes-Pedrosa
- Graduate Program on Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias, S/N, Petrópolis, Natal 59012-570, Brazil; Graduate Program on Biochemistry, Bioscience Center, University Campus, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Lagoa Nova, 59072-970 Natal, Brazil.
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31
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Goiset A, Darrigade AS, Labrèze C, Boralevi F, Milpied B. Aluminium sensitization in a French paediatric patch test population. Contact Dermatitis 2018; 79:382-383. [DOI: 10.1111/cod.13087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Goiset
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
| | | | - Christine Labrèze
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
| | - Franck Boralevi
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
| | - Brigitte Milpied
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
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32
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Raison-Peyron N, Genillier-Foin N, Bessis D, Milpied B. Atypical aluminium patch tests in children with persistent itching postvaccinal nodules. Pediatr Dermatol 2018; 35:531-532. [PMID: 29656425 DOI: 10.1111/pde.13481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Persistent itching nodules related to aluminium-adsorbed vaccines are well known in children with frequent positive patch tests to aluminium when tested. We report two cases of children with persistent postvaccination nodules who presented with atypical eruptions after aluminium patch tests.
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Affiliation(s)
- Nadia Raison-Peyron
- Department of Dermatology, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | | | - Didier Bessis
- Department of Dermatology, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Brigitte Milpied
- Department of Dermatology, Saint André Hospital, Bordeaux University Hospital, Bordeaux, France
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33
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Soares KSR, Gláucia-Silva F, Daniele-Silva A, Torres-Rêgo M, Araújo NKD, Menezes YASD, Damasceno IZ, Tambourgi DV, da Silva-Júnior AA, Fernandes-Pedrosa MDF. Antivenom Production against Bothrops jararaca and Bothrops erythromelas Snake Venoms Using Cross-Linked Chitosan Nanoparticles as an Immunoadjuvant. Toxins (Basel) 2018; 10:toxins10040158. [PMID: 29659491 PMCID: PMC5923324 DOI: 10.3390/toxins10040158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022] Open
Abstract
In Brazil, envenomation by snakes of the genus Bothrops is clinically relevant, particularly for the species Bothrops jararaca and B. erythromelas. The most effective treatment for envenomation by snakes is the administration of antivenoms associated with adjuvants. Novel adjuvants are required to reduce side effects and maximize the efficiency of conventional serum and vaccine formulations. The polymer chitosan has been shown to have immunoadjuvant properties, and it has been used as a platform for delivery systems. In this context, we evaluated the potential immunoadjuvant properties of chitosan nanoparticles (CNPs) loaded with B. jararaca and B. erythromelas venoms in the production of sera against these venoms. Stable CNPs were obtained by ionic gelation, and mice were immunized subcutaneously for 6 weeks with 100 µL of each snake venom at concentrations of 5.0 or 10.0% (w/w), encapsulated in CNPs or associated with aluminium hydroxide (AH). The evaluation of protein interactions with the CNPs revealed their ability to induce antibody levels equivalent to those of AH, even with smaller doses of antigen. In addition, the CNPs were less inflammatory due to their modified release of proteins. CNPs provide a promising approach for peptide/protein delivery from snake venom and will be useful for new vaccines.
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Affiliation(s)
- Karla Samara Rocha Soares
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Fiamma Gláucia-Silva
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Alessandra Daniele-Silva
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Manoela Torres-Rêgo
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Nathália Kelly de Araújo
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Yamara Arruda Silva de Menezes
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
| | - Igor Zumba Damasceno
- Department of Materials Engineering, Technology Center, University Campus, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil.
| | | | - Arnóbio Antônio da Silva-Júnior
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil.
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34
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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; 79:26-30. [DOI: 10.1111/cod.12977] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anette Gente Lidholm
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Annica Inerot
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Elisabet Bergfors
- Department of Primary Health Care, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Birger Trollfors
- Department of Paediatrics; Sahlgrenska University Hospital; Gothenburg Sweden
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35
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Nilsson L, Brockow K, Alm J, Cardona V, Caubet JC, Gomes E, Jenmalm MC, Lau S, Netterlid E, Schwarze J, Sheikh A, Storsaeter J, Skevaki C, Terreehorst I, Zanoni G. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol 2017; 28:628-640. [PMID: 28779496 DOI: 10.1111/pai.12762] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/15/2023]
Abstract
Immunization is highly effective in preventing infectious diseases and therefore an indispensable public health measure. Allergic patients deserve access to the same publicly recommended immunizations as non-allergic patients unless risks associated with vaccination outweigh the gains. Whereas the number of reported possible allergic reactions to vaccines is high, confirmed vaccine-triggered allergic reactions are rare. Anaphylaxis following vaccination is rare, affecting <1/100 000, but can occur in any patient. Some patient groups, notably those with a previous allergic reaction to a vaccine or its components, are at heightened risk of allergic reaction and require special precautions. Allergic reactions, however, may occur in patients without known risk factors and cannot be predicted by currently available tools. Unwarranted fear and uncertainty can result in incomplete vaccination coverage for children and adults with or without allergy. In addition to concerns about an allergic reaction to the vaccine itself, there is fear that routine childhood immunization may promote the development of allergic sensitization and disease. Thus, although there is no evidence that routine childhood immunization increases the risk of allergy development, such risks need to be discussed.
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Affiliation(s)
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - Johan Alm
- Sachs' Children and Youth Hospital and Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Maria C Jenmalm
- Unit of Autoimmunity and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Susanne Lau
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Eva Netterlid
- Department of Occupational and Environmental Dermatology, Lund University, Malmö, Sweden.,The Public Health Agency of Sweden, Stockholm, Sweden
| | - Jürgen Schwarze
- Child Life & Health and MRC-Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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36
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Beene KM, Bennett DD, Reeder MJ. Persistent pruritic subcutaneous nodules and hypopigmentation in a young boy. Pediatr Dermatol 2017; 34:708-710. [PMID: 29144041 DOI: 10.1111/pde.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin M Beene
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Daniel D Bennett
- Department of Dermatology, University of Wisconsin Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin Madison, School of Medicine and Public Health, Madison, WI, USA
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37
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Cabral-Miranda G, Heath MD, Gomes AC, Mohsen MO, Montoya-Diaz E, Salman AM, Atcheson E, Skinner MA, Kramer MF, Reyes-Sandoval A, Bachmann MF. Microcrystalline Tyrosine (MCT ®): A Depot Adjuvant in Licensed Allergy Immunotherapy Offers New Opportunities in Malaria. Vaccines (Basel) 2017; 5:vaccines5040032. [PMID: 28953265 PMCID: PMC5748599 DOI: 10.3390/vaccines5040032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/25/2017] [Accepted: 09/20/2017] [Indexed: 02/07/2023] Open
Abstract
Microcrystalline Tyrosine (MCT®) is a widely used proprietary depot excipient in specific immunotherapy for allergy. In the current study we assessed the potential of MCT to serve as an adjuvant in the development of a vaccine against malaria. To this end, we formulated the circumsporozoite protein (CSP) of P. vivax in MCT and compared the induced immune responses to CSP formulated in PBS or Alum. Both MCT and Alum strongly increased immunogenicity of CSP compared to PBS in both C57BL/6 and BALB/c mice. Challenge studies in mice using a chimeric P. bergei expressing CSP of P. vivax demonstrated clinically improved symptoms of malaria with CSP formulated in both MCT and Alum; protection was, however, more pronounced if CSP was formulated in MCT. Hence, MCT may be an attractive biodegradable adjuvant useful for the development of novel prophylactic vaccines.
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Affiliation(s)
- Gustavo Cabral-Miranda
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Matthew D Heath
- Allergy Therapeutics (UK) Ltd. Dominion Way, Worthing BN14 8SA, UK.
| | - Ariane C Gomes
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Mona O Mohsen
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Eduardo Montoya-Diaz
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Ahmed M Salman
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Erwan Atcheson
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Murray A Skinner
- Allergy Therapeutics (UK) Ltd. Dominion Way, Worthing BN14 8SA, UK.
| | | | - Arturo Reyes-Sandoval
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Martin F Bachmann
- Nuffield Department of Medicine, Centre for Cellular and Molecular Physiology (CCMP), The Jenner Institute, University of Oxford, Oxford OX3 7BN, UK.
- Immunology, RIA, Inselspital, University of Bern, 3010 Bern ,Switzerland.
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38
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Siemund I, Mowitz M, Zimerson E, Bruze M, Hindsén M. Variation in aluminium patch test reactivity over time. Contact Dermatitis 2017; 77:288-296. [DOI: 10.1111/cod.12836] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Ingrid Siemund
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
- Department of Dermatology and Venereology; Skåne University Hospital, Lund University; 221 85 Lund Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
| | - Erik Zimerson
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
| | - Monica Hindsén
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University; 205 02 Malmö Sweden
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39
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Virus-Like Particle (VLP) Plus Microcrystalline Tyrosine (MCT) Adjuvants Enhance Vaccine Efficacy Improving T and B Cell Immunogenicity and Protection against Plasmodium berghei/vivax. Vaccines (Basel) 2017; 5:vaccines5020010. [PMID: 28468322 PMCID: PMC5492007 DOI: 10.3390/vaccines5020010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 02/01/2023] Open
Abstract
Vaccination is the most effective prophylactic tool against infectious diseases. Despite continued efforts to control malaria, the disease still generally represents a significant unmet medical need. Microcrystalline tyrosine (MCT) is a well described depot used in licensed allergy immunotherapy products and in clinical development. However, its proof of concept in prophylactic vaccines has only recently been explored. MCT has never been used in combination with virus-like particles (VLPs), which are considered to be one of the most potent inducers of cellular and humoral immune responses in mice and humans. In the current study we assessed the potential of MCT to serve as an adjuvant in the development of a vaccine against malaria either alone or combined with VLP using Plasmodium vivax thrombospondin-related adhesive protein (TRAP) as a target antigen. We chemically coupled PvTRAP to VLPs derived from the cucumber mosaic virus fused to a universal T-cell epitope of the tetanus toxin (CMVtt), formulated with MCT and compared the induced immune responses to PvTRAP formulated in PBS or Alum. The protective capacity of the various formulations was assessed using Plasmodium berghei expressing PvTRAP. All vaccine formulations using adjuvants and/or VLP increased humoral immunogenicity for PvTRAP compared to the antigen alone. The most proficient responder was the group of mice immunized with the vaccine formulated with PvTRAP-VLP + MCT. The VLP-based vaccine formulated in MCT also induced the strongest T cell response and conferred best protection against challenge with recombinant Plasmodium berghei. Thus, the combination of VLP with MCT may take advantage of the properties of each component and appears to be an alternative biodegradable depot adjuvant for development of novel prophylactic vaccines.
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40
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Bergfors E, Trollfors B, Inerot A, Gente Lidholm A. Contact allergy to aluminium induced by commonly used pediatric vaccines. Clin Transl Med 2017; 6:4. [PMID: 28054277 PMCID: PMC5214894 DOI: 10.1186/s40169-016-0129-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/07/2016] [Indexed: 02/03/2023] Open
Affiliation(s)
- E Bergfors
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - B Trollfors
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Inerot
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Gente Lidholm
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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41
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Mineral Adjuvants∗∗The present chapter is an updated version of the chapter “Mineral Adjuvants,” published in Immunopotentiators in Modern Vaccines, p. 217–233. Ed. Virgil Schijns & Derek O'Hagan, Elsevier Science Publishers (2005). IMMUNOPOTENTIATORS IN MODERN VACCINES 2017. [PMCID: PMC7149584 DOI: 10.1016/b978-0-12-804019-5.00018-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mineral adjuvants comprise aluminum hydroxide and phosphate adjuvants as well as calcium phosphate adjuvants. In particular, the aluminum salts have achieved an undisputed status as the most commonly used adjuvants in human and veterinary vaccines. Calcium phosphate adjuvant, later discovered by Edgar Relyveld, constitutes a very interesting alternative and has also been applied both in human and veterinary vaccines. New analytical tools applied in adjuvant research are about to take us to the next level of understanding mineral adjuvants. These tools have been used to characterize mineral adjuvants, but so far, in particular, aluminum-based adjuvants in terms of surface marker expression profiles, isotypic profiles, and cytokine profiles. In the past 10 years, the discovery of adjuvant-mediated induction of the NALP3 inflammasome and its impact on the secretion of interleukin (IL)-1β and IL-18 as proinflammatory mediators in the early phases of immune response has been described as an important mechanism for the function of these adjuvants.
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42
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Lauren CT, Belsito DV, Morel KD, LaRussa P. Case Report of Subcutaneous Nodules and Sterile Abscesses Due to Delayed Type Hypersensitivity to Aluminum-Containing Vaccines. Pediatrics 2016; 138:peds.2014-1690. [PMID: 27677573 DOI: 10.1542/peds.2014-1690] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
Routine childhood immunizations have resulted in great reductions in vaccine-preventable infectious diseases. Vaccine-related adverse events, albeit rare, can be of significant consequence. Although anaphylaxis, or type I hypersensitivity, is recognized as a potential reaction after vaccination, delayed type hypersensitivity or type IV reactions are less so. We present a case of persistent subcutaneous nodules and sterile abscesses in the setting of delayed type hypersensitivity to aluminum, confirmed by patch testing and recurrence on re-exposure. We review sources of aluminum in common immunizations, principles for treatment, and strategies for management of future vaccinations for this patient.
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Affiliation(s)
- Christine T Lauren
- Departments of Dermatology, and .,Pediatrics, Columbia University Medical Center, New York, New York
| | | | - Kimberly D Morel
- Departments of Dermatology, and.,Pediatrics, Columbia University Medical Center, New York, New York
| | - Philip LaRussa
- Pediatrics, Columbia University Medical Center, New York, New York
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43
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Could aluminum be a new hidden allergen in type 1 hypersensitivity reactions when used as a drug additive? Postepy Dermatol Alergol 2016; 33:243-5. [PMID: 27512363 PMCID: PMC4969423 DOI: 10.5114/ada.2016.60620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
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44
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Guimarães LE, Baker B, Perricone C, Shoenfeld Y. Vaccines, adjuvants and autoimmunity. Pharmacol Res 2015; 100:190-209. [PMID: 26275795 PMCID: PMC7129276 DOI: 10.1016/j.phrs.2015.08.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/15/2022]
Abstract
Vaccines and autoimmunity are linked fields. Vaccine efficacy is based on whether host immune response against an antigen can elicit a memory T-cell response over time. Although the described side effects thus far have been mostly transient and acute, vaccines are able to elicit the immune system towards an autoimmune reaction. The diagnosis of a definite autoimmune disease and the occurrence of fatal outcome post-vaccination have been less frequently reported. Since vaccines are given to previously healthy hosts, who may have never developed the disease had they not been immunized, adverse events should be carefully accessed and evaluated even if they represent a limited number of occurrences. In this review of the literature, there is evidence of vaccine-induced autoimmunity and adjuvant-induced autoimmunity in both experimental models as well as human patients. Adjuvants and infectious agents may exert their immune-enhancing effects through various functional activities, encompassed by the adjuvant effect. These mechanisms are shared by different conditions triggered by adjuvants leading to the autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome). In conclusion, there are several case reports of autoimmune diseases following vaccines, however, due to the limited number of cases, the different classifications of symptoms and the long latency period of the diseases, every attempt for an epidemiological study has so far failed to deliver a connection. Despite this, efforts to unveil the connection between the triggering of the immune system by adjuvants and the development of autoimmune conditions should be undertaken. Vaccinomics is a field that may bring to light novel customized, personalized treatment approaches in the future.
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Affiliation(s)
- Luísa Eça Guimarães
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Britain Baker
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-kipp chair for research of autoimmune diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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45
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Two consecutive randomized controlled pertussis booster trials in children initially vaccinated in infancy with an acellular vaccine: The first with a five-component Tdap vaccine to 5-year olds and the second with five- or monocomponent Tdap vaccines at age 14-15 years. Vaccine 2015; 33:3717-25. [PMID: 26057135 DOI: 10.1016/j.vaccine.2015.05.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023]
Abstract
Prior study children from a DTaP efficacy trial were recruited at ages 5 and 15 years to randomized booster trials addressing immunogenicity and reactogenicity; 475 preschool children received mixed or separate injections of a reduced antigen vaccine (Tdap5, Sanofi Pasteur MSD) and an inactivated polio vaccine, and 230 adolescents received the same or another booster vaccine (Tdap1, SSI, Denmark). Pre-vaccination antibody concentrations against pertussis antigens were significantly higher at 15 than 5 years of age, probably due to natural boosting between the studies. Tdap5 induced comparable anti-PT concentrations at both ages, but antibody responses were significantly higher to filamentous haemagglutinin, pertactin and fimbriae 2/3 in adolescents. As expected, a higher amount of PT (Tdap1, 20μg) induced a stronger anti-PT response than a lower amount (Tdap5, 2.5μg). The frequency of adverse events was low and there were no serious adverse reactions. All local reactions had an early onset and a short duration. A large swelling or redness of more than half of the upper arm circumference was reported in 8/475 5-year-olds and in 6/230 15-year-olds. Children vaccinated with Tdap5 reported more moderate pain in adolescence than at preschool age, whereas itching was only reported in preschool children. Sweden introduced DTaP vaccines in 1996 after a 17-year hiatus with no general pertussis vaccination and pertussis was still endemic at the time of the studies. The frequency of adverse events was nevertheless low in both preschool children and adolescents and antibody responses were adequate. These studies document immunogenicity and reactogenicity in a trial cohort consecutively vaccinated with acellular pertussis vaccines from infancy to adolescence. The adolescent study was registered at ClinicalTrials.gov on 26 March 2009 (NCT00870350).
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Caubet JC, Ponvert C. Vaccine allergy. Immunol Allergy Clin North Am 2015; 50:132-137. [PMID: 25017679 DOI: 10.1016/j.iac.2014.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
Overdiagnosis of vaccine allergy is considered a major public health problem. This article discusses the different types of allergic reactions after immunization based on the timing (immediate vs nonimmediate) and the extent of the reaction (local vs systemic). The vaccine components potentially responsible for an allergic reaction are discussed, as well as the management of patients with a history of reaction to a specific vaccine and those with a history of allergy to one of the vaccine components.
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Affiliation(s)
- Jean-Christoph Caubet
- Department of Pediatrics, University Hospitals of Geneva and Medical School, University of Geneva, Geneva, Switzerland.
| | - Claude Ponvert
- Pulmonology & Allergology Service, Department of Pediatrics, Sick Children's Hospital, Paris, France
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Shaw CA, Li D, Tomljenovic L. Are there negative CNS impacts of aluminum adjuvants used in vaccines and immunotherapy? Immunotherapy 2014; 6:1055-71. [DOI: 10.2217/imt.14.81] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In spite of a common view that aluminum (Al) salts are inert and therefore harmless as vaccine adjuvants or in immunotherapy, the reality is quite different. In the following article we briefly review the literature on Al neurotoxicity and the use of Al salts as vaccine adjuvants and consider not only direct toxic actions on the nervous system, but also the potential impact for triggering autoimmunity. Autoimmune and inflammatory responses affecting the CNS appear to underlie some forms of neurological disease, including developmental disorders. Al has been demonstrated to impact the CNS at every level, including by changing gene expression. These outcomes should raise concerns about the increasing use of Al salts as vaccine adjuvants and for the application as more general immune stimulants.
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Affiliation(s)
- Christopher A Shaw
- Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada
| | - Dan Li
- Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada
| | - Lucija Tomljenovic
- Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada
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Bergfors E, Hermansson G, Nyström Kronander U, Falk L, Valter L, Trollfors B. 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; 173:1297-307. [PMID: 24752308 DOI: 10.1007/s00431-014-2318-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Elisabet Bergfors
- Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, PO Box 454, 40530, Gothenburg, Sweden,
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Kashiwagi Y, Maeda M, Kawashima H, Nakayama T. Inflammatory responses following intramuscular and subcutaneous immunization with aluminum-adjuvanted or non-adjuvanted vaccines. Vaccine 2014; 32:3393-401. [DOI: 10.1016/j.vaccine.2014.04.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 01/01/2023]
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