Long-Term Prognosis of Vaccine-Induced Contact Allergy to Aluminium

TAKE-HOME MESSAGE

• In this study, patients with contact allergy to an aluminium-containing vaccine in the 1990s were patch-tested to aluminium chloride hexahydrate 2%, along with other aluminum preparations, more than 15 years after their first patch test. Similar to findings of the second patch test performed 5 to 10 years after the first patch test, 75% of the patients with prior positive reactions tested negative in the third patch test.
• The findings of this article suggest that further vaccination with aluminium-containing vaccines in patients with prior vaccine granulomas carries a low risk for recurrent contact allergy reactions as children grow older.

–  Ruth McTighe, MD

Written by

 

 

JiaDe Yu MD, MS

Aluminum is one of the most common natural elements found in the earth's crust. It permeates our daily life from soda cans to laptop chassis, deodorant/antiperspirants, and immunotherapy used for allergen desensitization. Most importantly, aluminum is used in many life-saving vaccines to enhance immune response and increase efficacy. Vaccines containing aluminum include Hepatitis A, Hepatitis B, Anthrax, Meningococcal, DTaP, Tdap, human papillomavirus, etc. Aluminum hypersensitivity is estimated to occur in 5.1% of children but only 0.9% of adults. The most common presenting sign of aluminum hypersensitivity after childhood vaccination are subcutaneous granulomas that can either appear locally or distant relative to the site of vaccination. To bring attention to this, the American Contact Dermatitis Society has named Aluminum the 2022 Contact Allergen of the Year.

This prospective cohort study performed by Lidholm et al in Sweden examines the changing prevalence of aluminum allergy. The authors followed a cohort of children enrolled in the Gothenburg Pertussis Vaccine Trials in the 1990s who developed subcutaneous nodules (745 of 76,000). They were patch tested between 1998 and 2002 to aluminum (Cohort 1). Patients from the initial cohort were again patch tested to aluminum 5 years later (Cohort 2). This study focused on patients from the same cohort re-patch tested >15 years later (Cohort 3). 

In Cohort 1, 377 of 495 (76%) children who had a vaccine related granuloma were positive to aluminum. In Cohort 2 (5 years later), only 55 of 241 children initially positive in Cohort 1 (22.8%) had persistent positive reactions to aluminum while 77.2% of those initially positive turned negative. In Cohort 3 (>15 years later), only 5 of 20 (25%) children positive to aluminum in Cohort 2 were still positive. Interestingly, of the 11 children who were initially negative to aluminum in Cohort 2, 2 had positive testing to aluminum in Cohort 3. This seems to confirm that contact allergy to aluminum likely wanes over time possibly due to decreased exposure to aluminum containing vaccines as we age. Limitations to this study include the small sample size of Cohort 3 and lack of delayed reading as some metals may turn positive a week after patch testing.

Extrapolation of these results to other contact allergens is perhaps more interesting and relevant. Patients often wonder if they will "grow out" of allergens. While the jury is still out for more common contact allergens such as fragrances, methylisothiazolinone, formaldehyde, and nickel, for example, there is the possibility that with reduced exposure to contact allergens as regulations change, the prevalence of these allergens will also decrease with age. Prospective cohort studies should be done to determine if this is true.

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.

Contact Dermatitis

Long-term prognosis of vaccine-induced contact allergy to aluminium: Third patch-test with additional test preparations

Contact Derm 2023 Aug 07;[EPub Ahead of Print], AG Lidholm, A Inerot, M Gillstedt, E Bergfors, B Trollfors

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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