2018
DOI: 10.1111/pde.13390
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Delayed‐type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child

Abstract: A 3-year-old girl presented with a 7-month history of a waxing and waning left thigh mass associated with pruritus and erythema at the site of two previous DTaP-HepB-IPV vaccinations. Patch testing was positive to aluminum chloride, supporting a diagnosis of vaccine granuloma secondary to aluminum allergy; her symptoms had been well controlled with antihistamines and topical steroids. Injection site granulomas are a benign but potentially bothersome reaction to aluminum-containing immunizations that can be sup… Show more

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Cited by 13 publications
(17 citation statements)
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“…The risk increases with the number of vaccines given . Classically, these are presented as pruritic or tender subcutaneous nodules, which may associate localized hyperpigmentation, hypertrichosis, and eczema . Histology, although not required for diagnosis, shows nonencapsulated granulomas that stain positive for aluminum.…”
Section: Discussionmentioning
confidence: 99%
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“…The risk increases with the number of vaccines given . Classically, these are presented as pruritic or tender subcutaneous nodules, which may associate localized hyperpigmentation, hypertrichosis, and eczema . Histology, although not required for diagnosis, shows nonencapsulated granulomas that stain positive for aluminum.…”
Section: Discussionmentioning
confidence: 99%
“…It will also allow for appropriate recommendations for further immunizations. Patch testing is a sensitive and noninvasive diagnostic tool for patients presenting suggestive clinical features …”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…When performing ultrasound it is important to differentiate the VG from a common nodal echogenic hilum with its surrounding hypoechoic crescent‐shaped parenchymal layer, and from foreign body granuloma, often caused by injections of poorly resorbable hydrophobic oils or waxes . This granulomas presents as a round shaped, solid hypoechoic structure surrounding a foci of fat necrosis, which may leave hyperechogenic calcific spots showing a posterior acoustic shadow .…”
Section: Differential Diagnosismentioning
confidence: 99%
“…Patients or caregivers should be advised to apply a cold cloth at the injection site and use paracetamol as pain killer up to 15 mg/kg every 6-8 hours (27). Subcutaneous granulomas are benign itchy erythematous waxing and waning masses, secondary to hypersensitivity reactions to alum-adjuvanted vaccines, which can be treated with oral antihistamines and topical steroids (64).…”
Section: Management Of Reactionsmentioning
confidence: 99%