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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
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