Sonographic features of vaccination granulomas in children with delayed‐type hypersensitivity to aluminum

Sechi, Andrea; Patrizi, Annalisa; Vincenzi, Colombina; Savoia, Francesco; Tartari, Federico; Leuzzi, Miriam; Altobrando, Ambra Di; Besagni, Francesca; Merli, Yuri; Neri, Iria

doi:10.1111/pde.13953

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…6 A recent study on sonographic features of vaccination granulomas showed teardropshaped structures, suggesting the deposition of aluminium along the route of administration. 32 Hence, this mechanically impaired skin barrier might be of greater importance than the FLG-mutation.…”

Section: Discussionmentioning

confidence: 99%

“…Injection technique has previously been proposed as a risk factor for the development of vaccination granulomas, although granulomas have been described following both subcutaneous and intramuscular injections 6 . A recent study on sonographic features of vaccination granulomas showed teardrop‐shaped structures, suggesting the deposition of aluminium along the route of administration 32 . Hence, this mechanically impaired skin barrier might be of greater importance than the FLG‐mutation.…”

Section: Discussionmentioning

confidence: 99%

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Association between atopic disease and vaccination granulomas: A nested case–control study

Hoffmann,

Thiesson,

Johansen

et al. 2023

Contact Dermatitis

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BackgroundVaccination 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.ObjectiveTo investigate the association between vaccination granulomas and atopic dermatitis (AD), asthma and rhinitis in children.MethodsWe 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).ResultsThe 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).ConclusionAD 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between atopic disease and vaccination granulomas: A nested case–control study

Hoffmann,

Thiesson,

Johansen

et al. 2023

Contact Dermatitis

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“…Granulomas are pruritic nodules associated with local skin changes e.g. erythema, hypertrichosis, and discoloration [ 89 ]. Aluminium adjuvants have also been linked with increased rates of granuloma generation and a possible relation to chronic granulomatous inflammation, known as macrophagic myofasciitis [ 90 , 91 ].…”

Section: In Vivo Responses To Sav Technologiesmentioning

confidence: 99%

Single administration vaccines: delivery challenges, in vivo performance, and translational considerations

Michaelides,

Prasanna,

Badhan

et al. 2023

Expert Review of Vaccines

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Introduction With a limited global supply of vaccines and an increasing vaccine hesitancy, improving vaccination coverage has become a priority. Current vaccination regimes require multiple doses to be administered in a defined schedule where missed doses may lead to incomplete vaccine coverage and failure of immunization programmes. As such, there is an ever-increasing demand to convert multi-dose injectable vaccines into single-dose formats, often called single administration vaccines (SAVs). Areas covered This review summarizes recent developments in the field of SAVs, with a focus on pulsatile or controlled-release formulations. It will identify the technical challenges, translational as well as commercial barriers to SAVs development. Furthermore, the progress of SAV formulations for hepatitis B and polio vaccines will be reviewed thoroughly as case studies, with a focus on the development challenges and the preclinical immunogenicity/reactogenicity data. Expert opinion Despite the efforts to develop SAVs, few attempts have advanced to Phase-I trials. Considering the SAV development journey and bottlenecks, including commercial barriers from the early stages, may overcome some of the hurdles around the technology. The renewed global focus on vaccines since the COVID-19 pandemic could facilitate development of a new generation of technologies for pandemic preparedness including strategies for SAVs.

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“…Three out of the six patients (50%) had a well-defined smoothly ovoid or slightly lobulated, hypoechoic, avascular nodule in the deep subcutaneous fat of the lateral thigh [Figure 2 and 3 ], sonographically consistent with a granuloma. [ 2 3 ] Of these three patients, a single patient had two distinct nodules adjacent to one another. The lesions ranged from 0.8 to 2.6 cm (as taken by maximal dimension) with a mean size of 1.7 cm.…”

Section: Ase R Eportmentioning

confidence: 99%

The Evaluation of Palpable Thigh Nodularity in Vaccination-age Children – Differentiating Vaccination Granulomas from Other Causes

Mulholland

Joyce

Foran

et al. 2021

Journal of Medical Ultrasound

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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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Sonographic features of vaccination granulomas in children with delayed‐type hypersensitivity to aluminum

Cited by 5 publications

References 10 publications

Association between atopic disease and vaccination granulomas: A nested case–control study

Association between atopic disease and vaccination granulomas: A nested case–control study

Single administration vaccines: delivery challenges, in vivo performance, and translational considerations

The Evaluation of Palpable Thigh Nodularity in Vaccination-age Children – Differentiating Vaccination Granulomas from Other Causes

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