In a prospective cohort study on 4758 toddlers the frequency of granulomas was 0.63% in those who received a DTaP combination vaccine alone and 1.18% in those who received an Al adsorbed pneumococcal vaccine at the same time. The risk for granulomas increased with the number of Al containing vaccine doses.
The itching nodules appear remarkably late (months or even years) after the vaccination. Histopathological examination shows granuloma formations in which Al crystals can be demonstrated.
Clinically, pruritus is the dominating symptom with intense local itching in the vaccination area on the thigh, often causing skin alterations like eczema, hypertrichosis and hyperpigmentation. Intensified itching and swelling of the nodules is often reported when the child has a cold or another infection.
Contact allergy to aluminium was verified in 77–95% of children with itching vaccination granulomas…
Sensitized individuals have reported contact dermatitis after the use of Al containing deodorants, pharmaceutics (ear drops, antiseptics), sun protectors, tattooing pigments and metallic aluminium.
The consequences of future vaccination with Al adsorbed vaccines in children who once reacted with itching granulomas and/or contact allergy to Al is only partially studied.
In case of ongoing severe pruritus the next dose may be postponed 6–12 months.