Cargando…
Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis
Vaccination is a well-known trigger for mast cell degranulation in subjects affected by mastocytosis. Nevertheless, there is no exact standardized protocol to prevent a possible reaction after a vaccine injection, especially for patients who have already presented a previous vaccine-related adverse...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322976/ https://www.ncbi.nlm.nih.gov/pubmed/34335590 http://dx.doi.org/10.3389/fimmu.2021.688364 |
_version_ | 1783731154561531904 |
---|---|
author | Sarcina, Davide Giovannini, Mattia Oranges, Teresa Barni, Simona Pedaci, Fausto Andrea Liccioli, Giulia Canessa, Clementina Sarti, Lucrezia Lodi, Lorenzo Filippeschi, Cesare Azzari, Chiara Ricci, Silvia Mori, Francesca |
author_facet | Sarcina, Davide Giovannini, Mattia Oranges, Teresa Barni, Simona Pedaci, Fausto Andrea Liccioli, Giulia Canessa, Clementina Sarti, Lucrezia Lodi, Lorenzo Filippeschi, Cesare Azzari, Chiara Ricci, Silvia Mori, Francesca |
author_sort | Sarcina, Davide |
collection | PubMed |
description | Vaccination is a well-known trigger for mast cell degranulation in subjects affected by mastocytosis. Nevertheless, there is no exact standardized protocol to prevent a possible reaction after a vaccine injection, especially for patients who have already presented a previous vaccine-related adverse event, considering that these patients frequently tolerate future vaccine doses. For this reason, we aim to share our experience at Meyer Children’s University Hospital in Florence to raise awareness on the potential risk for future vaccinations and to discuss the valuable therapeutic strategies intended to prevent them, taking into account what is proposed by experts in literature. We describe the case of an 18-month-old female affected by a polymorphic variant of maculopapular cutaneous mastocytosis that presented an extensive bullous cutaneous reaction 24 hours after the second dose (booster dose) of inactivated-tetravalent influenza vaccine, treated with a single dose of oral corticosteroid therapy with betamethasone (0.1 mg/kg) and an oral antihistamine therapy with oxatomide (1 mg/kg/daily) for a week, until resolution. To the best of our knowledge, in the literature, no documented case of reaction to influenza vaccine in maculopapular cutaneous mastocytosis is described. Subsequently, the patient started a background therapy with ketotifen daily (0.05 mg/kg twice daily), a non-competitive H1-antihistamine, and a mast cell stabilizer (dual activity). A non-standardized pharmacological premedication protocol with an H1-receptor antagonist (oxatomide, 0.5 mg/kg) administered 12 hours before the immunizations, and a single dose of betamethasone (0.05 mg/kg) together with another dose of oxatomide (0.5 mg/kg) administered 2 hours before the injections was followed to make it possible for the patient to continue with the scheduled vaccinations. Indeed, no reactions were subsequently reported. Thus, in our experience, a background therapy with ketotifen associated with a premedication protocol made by two doses of oxatomide and a single dose of betamethasone was helpful to make possible the execution of the other vaccines. We suggest how in these children, it could be considered the idea of taking precaution when vaccination is planned, regardless of the kind of vaccine and if a dose of the same vaccine was previously received. However, international consensus needs to be reached to manage vaccinations in children with mastocytosis and previous adverse reactions to vaccines. |
format | Online Article Text |
id | pubmed-8322976 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83229762021-07-31 Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis Sarcina, Davide Giovannini, Mattia Oranges, Teresa Barni, Simona Pedaci, Fausto Andrea Liccioli, Giulia Canessa, Clementina Sarti, Lucrezia Lodi, Lorenzo Filippeschi, Cesare Azzari, Chiara Ricci, Silvia Mori, Francesca Front Immunol Immunology Vaccination is a well-known trigger for mast cell degranulation in subjects affected by mastocytosis. Nevertheless, there is no exact standardized protocol to prevent a possible reaction after a vaccine injection, especially for patients who have already presented a previous vaccine-related adverse event, considering that these patients frequently tolerate future vaccine doses. For this reason, we aim to share our experience at Meyer Children’s University Hospital in Florence to raise awareness on the potential risk for future vaccinations and to discuss the valuable therapeutic strategies intended to prevent them, taking into account what is proposed by experts in literature. We describe the case of an 18-month-old female affected by a polymorphic variant of maculopapular cutaneous mastocytosis that presented an extensive bullous cutaneous reaction 24 hours after the second dose (booster dose) of inactivated-tetravalent influenza vaccine, treated with a single dose of oral corticosteroid therapy with betamethasone (0.1 mg/kg) and an oral antihistamine therapy with oxatomide (1 mg/kg/daily) for a week, until resolution. To the best of our knowledge, in the literature, no documented case of reaction to influenza vaccine in maculopapular cutaneous mastocytosis is described. Subsequently, the patient started a background therapy with ketotifen daily (0.05 mg/kg twice daily), a non-competitive H1-antihistamine, and a mast cell stabilizer (dual activity). A non-standardized pharmacological premedication protocol with an H1-receptor antagonist (oxatomide, 0.5 mg/kg) administered 12 hours before the immunizations, and a single dose of betamethasone (0.05 mg/kg) together with another dose of oxatomide (0.5 mg/kg) administered 2 hours before the injections was followed to make it possible for the patient to continue with the scheduled vaccinations. Indeed, no reactions were subsequently reported. Thus, in our experience, a background therapy with ketotifen associated with a premedication protocol made by two doses of oxatomide and a single dose of betamethasone was helpful to make possible the execution of the other vaccines. We suggest how in these children, it could be considered the idea of taking precaution when vaccination is planned, regardless of the kind of vaccine and if a dose of the same vaccine was previously received. However, international consensus needs to be reached to manage vaccinations in children with mastocytosis and previous adverse reactions to vaccines. Frontiers Media S.A. 2021-07-15 /pmc/articles/PMC8322976/ /pubmed/34335590 http://dx.doi.org/10.3389/fimmu.2021.688364 Text en Copyright © 2021 Sarcina, Giovannini, Oranges, Barni, Pedaci, Liccioli, Canessa, Sarti, Lodi, Filippeschi, Azzari, Ricci and Mori https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Sarcina, Davide Giovannini, Mattia Oranges, Teresa Barni, Simona Pedaci, Fausto Andrea Liccioli, Giulia Canessa, Clementina Sarti, Lucrezia Lodi, Lorenzo Filippeschi, Cesare Azzari, Chiara Ricci, Silvia Mori, Francesca Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis |
title | Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis |
title_full | Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis |
title_fullStr | Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis |
title_full_unstemmed | Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis |
title_short | Case Report and Review of the Literature: Bullous Skin Eruption After the Booster-Dose of Influenza Vaccine in a Pediatric Patient With Polymorphic Maculopapular Cutaneous Mastocytosis |
title_sort | case report and review of the literature: bullous skin eruption after the booster-dose of influenza vaccine in a pediatric patient with polymorphic maculopapular cutaneous mastocytosis |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322976/ https://www.ncbi.nlm.nih.gov/pubmed/34335590 http://dx.doi.org/10.3389/fimmu.2021.688364 |
work_keys_str_mv | AT sarcinadavide casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT giovanninimattia casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT orangesteresa casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT barnisimona casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT pedacifaustoandrea casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT liccioligiulia casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT canessaclementina casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT sartilucrezia casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT lodilorenzo casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT filippeschicesare casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT azzarichiara casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT riccisilvia casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis AT morifrancesca casereportandreviewoftheliteraturebullousskineruptionaftertheboosterdoseofinfluenzavaccineinapediatricpatientwithpolymorphicmaculopapularcutaneousmastocytosis |