Vaccine granuloma

Occurrence of itchy dermal nodules or nodules that appear within weeks to months after vaccination.

Type IV sensitisation to the adjuvants used in vaccines (mostly aluminium salts) is often present. In vaccines, aluminium salts are potent adjuvants e.g. in vaccines against tetanus, diphtheria, poliomyelitis, hepatitis A and hepatitis B. Contact allergies resulting from vaccinations, unlike nonallergic foreign body reactions to aluminum salts, develop with a time delay within weeks to months after vaccinations. The granulomas may persist for years. The itching frequently exacerbates in the context of infections!

The granulomas may persist for years. The pruritus frequently exacerbates in the course of upper respiratory tract infections, after further vaccinations with inactivated vaccines, during specific immunotherapies or when using antiperspirants containing aluminium. Diagnosis is made by detection of type IV sensitisation in the epicutaneous test (2% aluminium chloride hexahydrate vaseline). Symptomatic therapy with H1-blockers (e.g. cetericine) and topical glucocorticoids is recommended. The symptoms may flare up again with renewed infections.

Mostly blurred dermal infiltrates of lymphocytes, eosinophilic leukocytes and macrophages, mostly surrounded by a fibrotic rim.

1. Wahl RU et al (2014) Vaccination granuloma in late type allergy to aluminum salts. dermatologist 65: 384-386