scholarly journals Delayed allergic skin reactions to vaccines

2022 ◽  
Vol 43 (1) ◽  
pp. 20-29 ◽  
Author(s):  
Marcella R. Aquino ◽  
Theresa A. Bingemann ◽  
Anil Nanda ◽  
Kelly M. Maples
Keyword(s):  
Patch Testing ◽  
Case Reports ◽  
Delayed Hypersensitivity ◽  
Delayed Type Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Skin Reactions ◽  
Cutaneous Manifestations ◽  
Systemic Corticosteroids ◽  
Causative Agents ◽  
Delayed Reactions

Background: Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because both immediate and delayed hypersensitivity reactions have been reported. Objective: This literature review focused on delayed reactions to vaccines, including possible causative agents and practical information on how to diagnose, evaluate with patch testing, and manage subsequent dose administration. Methods: Currently published reviews and case reports in PubMed, along with data on vaccines from the Centers for Disease Control and Prevention web site. Relevant case reports and reviews that focused on delayed reactions to vaccines were selected. Results: Most delayed hypersensitivity reactions to vaccines include cutaneous manifestations, which vary from local persistent pruritic nodules to systemic rashes. The onset is usually within a few days but can be delayed by weeks. Multiple excipients have been identified that have been implicated in delayed vaccine reactions, including thimerosal, formaldehyde, aluminum, antibiotics, and gelatin. Treatment with antihistamines, topical corticosteroids, or systemic corticosteroids alleviates symptoms in most patients. Such reactions are generally not contraindications to future vaccination. However, for more-severe reactions, patch testing for causative agents can be used to aid in diagnosis and approach further vaccination. Conclusion: Delayed-type hypersensitivity reactions to vaccines are not uncommon. If needed, patch testing can be used to confirm agents, including antibiotics, formaldehyde, thimerosal, and aluminum. In most cases, delayed cutaneous reactions are not contraindications to further vaccine administration.

scholarly journals Augmentation of delayed-type hypersensitivity by doses of cyclophosphamide which do not affect antibody responses.

1975 ◽  
Vol 141 (3) ◽  
pp. 697-702 ◽  
Author(s):  
P W Askenase ◽  
B J Hayden ◽  
R K Gershon
Keyword(s):  
T Cells ◽  
Antibody Responses ◽  
Delayed Type Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Low Doses ◽  
Hypersensitivity Response ◽  
Suppressor T Cells ◽  
Cyclophosphamide Treatment ◽  
Delayed Reactions ◽  
Foot Pad

Mice immunized with more SRBC than are required to produce optimal delayed-type hypersensitivity reactions, developed good antibody responses and poor delayed foot pad reactions. Cyclophosphamide treatment in low doses (20 mg/kg) before immunization, augmented the delayed-type hypersensitivity without affecting antibody responses. Cyclophosphamide did not augment delayed responses to optimal doses of SRBC (0.01%), but did augment the delayed hypersensitivity response of mice immunized with a suboptimal antigen dose (0.001%); which produced no detectable antibody response with or without cyclophosphamide pretreatment. These results suggest that antibody feedback is not the sole regulator of delayed reactions; the possibility that suppressor T cells may also be involved is discussed.

Hypersensitivity reactions to low molecular weight heparins: different patterns of cross-reactivity in 3 patients

2018 ◽  
Vol 96 (4) ◽  
pp. 428-432 ◽  
Author(s):  
Danica Juricic Nahal ◽  
Ivana Cegec ◽  
Viktorija Erdeljic Turk ◽  
Ksenija Makar Ausperger ◽  
Iva Kraljickovic ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Challenge Test ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Delayed Type Hypersensitivity ◽  
Low Molecular Weight ◽  
Hypersensitivity Reactions ◽  
Low Molecular Weight Heparins ◽  
Safe Alternative ◽  
Delayed Reactions

Low molecular weight heparins (LMWHs) are used for a variety of indications. The most common type of hypersensitivity reactions to LMWHs are delayed-type hypersensitivity reactions (DHR). Immediate-type hypersensitivity reactions (IHR) occur only sporadically. Cross-reactivity of different LMWHs is a common and unpredictable problem. We present 2 cases of patients who developed DHR to nadroparin and enoxaparin, respectively. The third case presents a patient who developed IHR to nadroparin. Skin tests confirmed the hypersensitivity in all cases. In the cases of DHR, a skin test negative LMWH was identified and was tolerated in a challenge test. In the IHR case, cross-reactivity to all tested LMWHs was established. We hypothesize that the degree of cross-reactivity might depend on the type of hypersensitivity reaction with immediate reactions linked to more extensive cross-reactivity than delayed reactions. This is important to consider because, at least in some cases, a safe alternative LMWH can be identified.

scholarly journals Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature

2019 ◽  
Vol 13 (2) ◽  
pp. 144-157 ◽  
Author(s):  
Gianfranco Calogiuri ◽  
Lene H. Garvey ◽  
Eustachio Nettis ◽  
Paolo Romita ◽  
Elisabetta Di Leo ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Case Reports ◽  
Management Strategies ◽  
Skin Tests ◽  
Delayed Type Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Type Reaction ◽  
Drug Eruptions ◽  
Skin Allergy ◽  
Meta Analyses

Background: Antifungal azoles are the first-line agents used to treat topical and, above all, systemic mycosis. The latter could be life-threating infections in immunocompromised patients. Chemotherapeutic antibiotics, including antifungal azoles, may induce hypersensitivity reactions; however, such immunologic adverse reactions have not been defined and carefully investigated. Objective: The study aims to provide an update on the evaluation and diagnosis of skin allergy to azole antifungal agents. Methods: This is a systematic review performed on PubMed and Google Schoolbarusing using the key terms “allergy, hypersensitivity, anaphylaxis, immediate-type reaction, delayed-type reaction, ketoconazole, fluconazole, posaconazole, voriconazole, itraconazole, triazoles, imidazoles, antifungals, antimycotics”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews and case reports. Results: One hundred twenty-four articles matched our search terms. The most common adverse events reported were T-cell mediated delayed-type hypersensitivity reactions, fixed drug eruptions, exanthematous dermatitis, Steven-Johnson syndrome, toxic epidermal necrolysis and acute generalized exhanthematous pustulosis. Rarely a drug rash with eosinophilia systemic symptoms, has been described. Also, immediate-type reactions such as urticaria-angioedema or anaphylaxis have been reported following the administration of antifungal imidazoles, although not so frequently. Conclusion: Despite their widespread use, triazoles seem to induce rare cutaneous hypersensitivity reactions, but the pathomechanisms, risk factors, diagnostic and management strategies, including skin tests and challenge tests, are little known and poorly investigated.

scholarly journals STUDIES ON DELAYED HYPERSENSITIVITY

1965 ◽  
Vol 121 (6) ◽  
pp. 873-888 ◽  
Author(s):  
Bernard B. Levine
Keyword(s):  
Guinea Pig ◽  
Guinea Pigs ◽  
Antigenic Determinant ◽  
Cross Reactivity ◽  
Delayed Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Binding Affinities ◽  
Structural Adaptation ◽  
Skin Reactions ◽  
High Binding

Experiments carried out with several well defined antigenic systems (hapten conjugates of poly-L-lysine and guinea pig serum albumin) in guinea pigs demonstrated that: 1. Arthus reactions also manifest carrier specificity, although to a smaller extent than do delayed hypersensitivity reactions. 2. Desensitization by injection of minute doses of antigen results in moderate specific desensitization of delayed hypersensitivity without desensitization of Arthus reactivity to the same antigenic determinant. 3. Insoluble antigen-antibody complexes prepared from high affinity guinea pig antibodies can elicit specific delayed skin reactions in sensitized guinea pigs. 4. Homologous conjugates of structurally similar haptens show considerably less cross-reactivity in delayed reactions than in immediate hypersensitivity reactions to the same antigenic determinant. These experimental results are interpreted as indicating that delayed hypersensitivity reactions in the guinea pig are mediated by "antibodies" of comparatively high binding affinities. High binding affinities are achieved for these antibodies more likely by closer structural adaptation between antigen and antibody than by a larger area of specific contact.

scholarly journals Features of delayed hypersensitivity reactions to iodinated contrast media diagnosis. Clinical cases

2013 ◽  
Vol 10 (3) ◽  
pp. 35-40
Author(s):  
N V Lebedeva ◽  
T N Myasnikova ◽  
T V Latysheva
Keyword(s):  
Contrast Media ◽  
Delayed Hypersensitivity ◽  
Skin Tests ◽  
Delayed Type Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
History Of ◽  
Clinical Cases

The article presents the proprietary data of the survey of patients who had undergone a history of hypersensitivity reactions after administration of iodinated contrast media (RCM), the estimation of skin tests with RCM in these patients and two clinical cases of patients who had a history of delayed-type hypersensitivity.

Lung Delayed Hypersensitivity. A case with particular features

2018 ◽  
Vol 69 (8) ◽  
pp. 2071-2073
Author(s):  
Mihaela Prodea ◽  
Eugen Radu Boia ◽  
Raluca Amalia Ceausu ◽  
Cosmin Librimir ◽  
Gheorghe Iovanescu ◽  
...  
Keyword(s):  
T Cells ◽  
Delayed Hypersensitivity ◽  
Delayed Type Hypersensitivity ◽  
Mononuclear Leukocytes ◽  
Hypersensitivity Reactions ◽  
Inflammatory Reactions ◽  
Type Iv

Delayed hypersensitivity reactions are inflammatory reactions initiated by mononuclear leukocytes. These reactions are mediated by T cells and monocytes/macrophages rather than by antibodies. We describe a case of 50 years old man with lung type IV hypersensitivity. The case of lung delayed hypersensitivity presented has some particular histopathological and immunohistochemical features. The diagnosis of lung delayed type hypersensitivity requires analysis of correlation between clinic, radiographic, physiologic and pathologic criteria.

scholarly journals IMMUNOLOGICAL SPECIFICITY OF DELAYED AND IMMEDIATE HYPERSENSITIVITY REACTIONS

1962 ◽  
Vol 115 (5) ◽  
pp. 1023-1036 ◽  
Author(s):  
B. Benacerraf ◽  
B. B. Levine
Keyword(s):  
Guinea Pig ◽  
Aminocaproic Acid ◽  
Carbon Chain ◽  
Delayed Hypersensitivity ◽  
Carrier Protein ◽  
Hypersensitivity Reactions ◽  
Carrier Proteins ◽  
Immediate Hypersensitivity ◽  
Immunological Specificity ◽  
Delayed Reactions

The effects of the following parameters on the immunologic specificity of delayed and immediate hypersensitivity reactions were investigated in the guinea pig using the picryl and p-toluenesulfonyl systems: (a) the contribution of the carrier protein, (b) the effect of the number of hapten groups per molecule of the immunizing and challenging antigens, and (c) the effect of interposing a 6 carbon chain (ϵ-aminocaproic acid) between the hapten and its usual attachment to the lysine ϵ-NH2 groups of the carrier protein. It was found that induction of delayed hypersensitivity was accomplished equally well with both lightly and heavily coupled conjugates. Sensitized animals which gave strong delayed reactions to the immunizing conjugate cross-reacted poorly or not at all to (a) conjugates of the same hapten with a different carrier protein, or (b) conjugates differing from the immunizing conjugate by having an ϵ-aminocaproyl chain interposed between hapten and its attachment onto the carrier protein. Animals sensitized with either lightly or heavily substituted conjugates exhibited strong delayed reactions to both conjugates, but more intense reactions to the immunizing conjugate were always observed. In contrast to the marker carrier specificity exhibited by the delayed hypersensitivity reactions, immediate hypersensitivity reactions, (specific precipitation, Arthus, and PCA reactions) could be elicited equally well with hapten conjugates of all carrier proteins, as well as with conjugates containing ϵ-aminocaproyl chains interposed between hapten and the carrier protein, provided the number of hapten groups per molecule conjugate was sufficiently high. Both in inducing antibody response and in provoking immediate hypersensitivity reactions, heavily substituted conjugates were considerably more effective than were lightly substituted conjugates. Alternative explanations for these observed differences in specificity between immediate and delayed hypersensitivity reactions are discussed.

scholarly journals ROLE OF THE CLOTTING SYSTEM IN CELL-MEDIATED HYPERSENSITIVITY

1973 ◽  
Vol 138 (3) ◽  
pp. 686-698 ◽  
Author(s):  
Robert B. Colvin ◽  
Richard A. Johnson ◽  
Martin C. Mihm ◽  
Harold F. Dvorak
Keyword(s):  
Mononuclear Cells ◽  
Fluorescent Antibody ◽  
Delayed Hypersensitivity ◽  
Delayed Type Hypersensitivity ◽  
Fluorescent Antibody Technique ◽  
Clotting System ◽  
Skin Reactions ◽  
Reticular Dermis ◽  
Antibody Technique ◽  
Hypersensitivity Skin

The expression of delayed-type hypersensitivity in animals has been inhibited by a variety of anticoagulants, but direct evidence for activation of clotting in the evolution of these reactions has been lacking. Using the fluorescent antibody technique we here demonstrate that fibrin deposition is a prominent and consistent feature of both allergic contact dermatitis and classic delayed hypersensitivity skin reactions in man. Fib was detected in 55 of 58 delayed reactions studied at the peak of their intensity. The characteristic distribution of Fib—principally in the intervascular portions of the reticular dermis with sparing of vessels and their associated cuffs of mononuclear cells—is unusual and quite different from that described in antibody-mediated lesions in animals or man. Fib was found in vessel walls in only 2 of 94 biopsies studied. With a single exception, deposition of immunoglobulins and complement was not observed. The pathogensis and significance of Fib deposition in these reactions are not yet clear. Fib is ultimately derived from circulating fibrinogen, and its accumulation provides additional evidence for locally increased vascular permeability in delayed hypersensitivity. Polymerization of extravascular fibrinogen could be triggered nonspecifically by dermal elements (e.g., collagen) or by a product of sensitized lymphocytes. The appearance of Fib early in the development of these reactions (4–8 h after epicutaneous test with DNCB) and inhibition studies with anticoagulants together suggest that clotting may have a role in their pathogenesis, possibly by the release of bioactive peptides from fibrinogen/fibrin or by contributing to the induration characteristic of delayed hypersensitivity.

scholarly journals LOCATION OF THE ANTIGEN, ANTIBODY AND ANTIGEN-ANTIBODY COMPLEXES IN DELAYED-TYPE HYPERSENSITIVITY SKIN REACTIONS TO HORSERADISH PEROXIDASE

1972 ◽  
Vol 20 (8) ◽  
pp. 604-620 ◽  
Author(s):  
WERNER STRAUS
Keyword(s):  
Horseradish Peroxidase ◽  
Cell Surface ◽  
Mononuclear Cells ◽  
Tissue Injury ◽  
Collagen Fibers ◽  
Delayed Hypersensitivity ◽  
Delayed Type Hypersensitivity ◽  
Considerable Proportion ◽  
Skin Reactions ◽  
Antigen Antibody

The sites of intradermally injected horseradish peroxidase (HRP), of its antibody and of HRP-anti-HRP antibody complexes were investigated in the dermis of rabbits showing strong skin reactions of delayed hypersensitivity against HRP. Comparison was made with the location of intradermally injected HRP and its antibody in the dermis of immunized rabbits showing slight degrees of hypersensitivity of a nondelayed type and with the location of intradermally injected HRP in the dermis of nonimmunized animals. In all skin reactions of delayed hypersensitivity, a considerable proportion of the injected antigen was associated with collagen fibers, the reaction product appearing as "dots," "rodlets" and "strands" in linear array on individual collagen fibers in the interior of the bundles or as strands coating the outermost surface of the bundles. The reaction for the antibody was positive at the same sites. It was suggested that receptors for antigen-antibody complexes may be associated with collagen fibers. Free granular deposits containing antigen-antibody complexes seemed to originate from the collagen-associated granules after their enlargement and release. The extracellular granules often adhered to the antibody-positive surface membranes of lymphocytes. Other granular deposits (antigen-antibody complexes) seemed to be phagocytosed by monocytes (macrophages) and fibroblasts. In areas of tissue injury in the upper dermis, many mononuclear cells showed the reaction for the antibody on their cell surface. Aggregations of such cells were often located close to disintegrating bundles of collagen fibers. It was suggested that the encounter of the antigen and the antibody (antigen-antibody complexes) on the surfaces of cells and of collagen may trigger the release of cytotoxic factors. A few lymphocytes in the dermis of hypersensitive rabbits contained the specific antibody on their cell surface before skin lesions were elicited.

scholarly journals Processionary caterpillar reactions in Southern Italy forestry workers: description of three cases

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Luisa Ricciardi ◽  
Concetto Giorgianni ◽  
Giusi Briguglio ◽  
Sebastiano Gangemi ◽  
Giovanna Spatari
Keyword(s):  
Occupational Exposure ◽  
Southern Italy ◽  
Correct Diagnosis ◽  
Hypersensitivity Reactions ◽  
Skin Reactions ◽  
Outdoor Workers ◽  
Ocular Symptoms ◽  
Forestry Workers ◽  
Systemic Corticosteroids ◽  
Health Physician

Abstract Background Processionary caterpillar (PC), also named Thaumatopea pityocampa, has been reported to cause hypersensitivity reactions after contact with a toxin contained in hair-like bristles which cover this insect. Occupational exposure to PC is underestimated in outdoor workers and especially in forestry workers (FW) and is globally diffusing because of rising temperatures. Cases presentation We present the first three cases of FW from Sicily, a Southern Italy (SI) region, which reported hypersensitivity reactions due to exposure to PC infested trees. These cases were identified by the occupational health physician during the annual screening of FW working in the Mountains of north-eastern Sicily. Interviewing a population of 630 FW, 1 male and 2 females reported direct contact skin reactions together with airborne contact reactions to PC hairs causing mild respiratory symptoms in two cases and ocular symptoms in one case, which needed treatment with systemic corticosteroids and antihistamines. Conclusions This is the first report of hypersensitivity reactions in SI FW due to occupational exposure to PC. Further screenings not only in FW but also in other populations of outdoor workers are needed in order to assess the real incidence of contact and airborne reactions due to occupational exposure to PC. Though so far no correlation has been found with atopy, it seems apparent that the reactions occur in susceptible subjects; further research is needed for a correct diagnosis and to identify possible desensitization procedures.

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