| 1. |
- Bergfors, Elisabet, et al.
(author)
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A child with a long-standing, intensely itching subcutaneous nodule on a thigh : an uncommon (?) reaction to commonly used vaccines
- 2013
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In: BMJ Case Reports. - : BMJ Publishing Group. - 1757-790X.
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Journal article (peer-reviewed)abstract
- A 2-year-old girl presented with an intensely itching subcutaneous nodule on the front of a thigh. The nodule persisted for 10 months until it was excised. Subsequent investigation for malignancy and systemic disease showed no pathological findings. The diagnosis, persistent itching vaccination granuloma, was revealed by hazard almost 2 years after the onset of symptoms. Persistent itching subcutaneous nodules at the injection site for aluminium containing vaccines (mostly diphtheria-tetanus-pertussis combination vaccines for primary immunisation of infants) may appear with a long delay after the vaccination (months), cause prolonged itching (years) and are often associated with contact allergy to aluminium. The condition is poorly recognised in Health Care which may lead to prolonged symptoms and unnecessary investigations.
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| 2. |
- Bergfors, Elisabet, et al.
(author)
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How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study
- 2014
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In: European Journal of Pediatrics. - : Springer Berlin/Heidelberg. - 0340-6199 .- 1432-1076. ; 173:10, s. 1297-1307
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Journal article (peer-reviewed)abstract
- The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. Conclusion: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.
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| 3. |
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| 4. |
- Bergfors, Elisabet, et al.
(author)
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Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines-prognosis and outcome after booster vaccination
- 2013
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In: European Journal of Pediatrics. - : Springer. - 0340-6199 .- 1432-1076. ; 172:2, s. 171-177
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Journal article (peer-reviewed)abstract
- Persistent itching subcutaneous nodules and aluminium (Al) allergy have been described after vaccination with Al-adsorbed vaccines but are considered rare. Little is known about the prognosis. Sixty-four children with itching nodules following vaccination with diphtheria-tetanus-pertussis (DTP) vaccines currently used in Sweden (Infanrix® and Pentavac®) were spontaneously reported to the authors from 1999 and followed for up to 12 years. The median duration of itching was 5 years in the 44 children who were free or almost free from symptoms at the latest follow-up. Typical findings were a long interval between vaccination and onset of symptoms (months or years) and intensified itching during intercurrent infections. Contact allergy to aluminium was demonstrated in 60/63 children (95 %). Neither the incidence nor differences between the two vaccines can be estimated from this study, but vaccine-induced itching nodules are probably more common than hitherto realised. The median interval between onset of symptoms and diagnosis was 8 months in a region where nurses were educated to recognise the condition compared to 2 years in other regions. Booster vaccination with DTP-polio was postponed or declined by 15/40 families in fear for new problems. Out of 25 children who received a booster dose, only two had new itching nodules. Conclusion: Intensely itching subcutaneous nodules (vaccination granulomas) and contact allergy to aluminium may occur after primary vaccination with the two most commonly used DTP vaccines in Europe. The condition is probably underreported. Symptoms may last for at least 4-5 years but eventually seem to subside.
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| 5. |
- Gente-Lidholm, Anette, et al.
(author)
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Loss of patch-test reaction to aluminium years after vaccination with aluminium adjuvants in a population of 76.000 children.
- 2010
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In: Contact Dermatitis. - 0105-1873 .- 1600-0536.
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Conference paper (peer-reviewed)abstract
- During trials of aluminium adsorbed diphtheria–rntetanus/acellular pertussis vaccines from a single producer,rnpersistent intensely itching nodules at the vaccination site werernobserved in an unexpectedly high frequency (about 1%) in thernstudy area around Gothenburg, Sweden. All afflicted childrenrnwere offered patch testing for aluminium. Among the childrenrnsensitisation to aluminium was demonstrated in a highrnfrequency (77%). The children demonstrated positive patchrntests for aluminium were offered to repeat the test 5 years later.rnObjectives: To study the clinical course of itching nodules andrncontact allergy to aluminium.rnMethods: Two hundred and fifty children with itching nodulesrnat the injection site after vaccination with aluminium adsorbedrndiphtheria–tetanus/acellular pertussis vaccines that earlier hadrnshown a positive patch test reaction to aluminium, wherernrepeated the patch test more than 5 years later. Thernchildren were patch tested in the same way as beforernwith aluminiumchloridehexahydrate 2% in petrolatumrn(Chemotechnique Diagnostics, Sweden) in plastic chambersrnfrom the same manufacturer, and also with an empty FinnrnChamber (Epitest, Finland). The tests were read on day threernusing the ICDRG’s criteria.rnResults: Among the 250 children tested, approximately 75% hadrnno remaining positive patch test to aluminium. Only a few of thernchildren presented still itching nodules.rnConclusion: Three out of four children with earlier shownrncontact allergy to aluminium had lost their patch testrnreactivity 5 years later.
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| 6. |
- Grodzinsky, Ewa, et al.
(author)
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Could gastrointestinal disorders differ in two close but divergent social environments?
- 2012
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In: International Journal of Health Geographics. - : BioMed Central. - 1476-072X. ; 11:5
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Journal article (peer-reviewed)abstract
- Background: Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city. less thanbrgreater than less thanbrgreater thanMethods: We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care. less thanbrgreater than less thanbrgreater thanResults: Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment. less thanbrgreater than less thanbrgreater thanConclusions: Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.
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| 7. |
- Lidholm, Anette Gente, et al.
(author)
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Unexpected loss of contact allergy to aluminium induced by vaccine
- 2013
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In: Contact Dermatitis. - : John Wiley & Sons. - 0105-1873 .- 1600-0536. ; 68:5, s. 286-292
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Journal article (peer-reviewed)abstract
- BACKGROUND:In studies in Gothenburg, Sweden, in the 1990s of an aluminium hydroxide-adsorbed pertussis toxoid vaccine, 745 of ~76 000 vaccinated children developed long-lasting itchy subcutaneous nodules at the vaccination site. Of 495 children with itchy nodules patch tested for aluminium allergy, 376 (76%) were positive.OBJECTIVES:To study the prognosis of the vaccine-induced aluminium allergy.PATIENTS AND METHODS:Two hundred and forty-one children with demonstrated aluminium allergy in the previous study were patch tested again 5-9 years after the initial test, with the same procedure as used previously.RESULTS:Contact allergy to aluminium was no longer demonstrable in 186 of the retested 241 children (77%). A negative test result was more common in children who no longer had itching at the vaccination site; it was also related to the age of the child, the time after the first aluminium-adsorbed vaccine dose, and the strength of the reaction in the first test.CONCLUSIONS:Patch test reactivity to aluminium seems to disappear or weaken with time.
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