CHRONIC SPONTANEOUS URTICARIA FOLLOWING VACCINATION

Autoimmune/auto-inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome) has been suggested for symptoms which appear following vaccination or exposure to several adjuvants. We hypothesized that CSU might be a part of Shoenfeld's syndrome following vaccination. We studied all 1197 cases of CSU to identify patients that had received vaccinations during the twelve weeks prior the first documentation of CSU symptoms and identified 14 eligible subjects who developed CSU with 12 weeks of vaccination. Dates of vaccinations, local and immediate adverse events, as well as clinical manifestations and their temporal relation to the vaccinations were collected. The Shoenfeld's syndrome criteria were applied to each patient. Eight of the 14 patients (57.1 %) were females. Three (21.4%) patients received HBV vaccine (all three patients received two doses at month 0 and 1 of HBV vaccine inoculations), 3 (21.4 %) received HPV vaccine (one dose), 4 (28.6 %) received influenza vaccine, 2 (14.3 %) received Yellow fever vaccine and 2 (14.3 %) received DTP vaccine. The mean latency period from last vaccination and onset of CSU symptoms was 8.4 days. Autologous serum skin test was positive in 9 (64.3 %) patients. Other clinical manifestations included postural intolerance, tension headaches, sleep disturbances, chronic fatigue, arthralgia, myalgia and irritable bowel disease. Anti-nuclear antibodies were positive in 6 (42.8 %) patients, 4 (28.5 %) tested positive for anti-SSA and anti SSB, 2 (14.3 %) patients for anti-RNP. Either anti-TPO or anti-thyroglobulin antibodies were detected in 10 (71.4 %) patients. This study suggests an association between vaccinations and CSU, as part of the Shoenfeld's syndrome. Further studies are needed to support our observation and to elucidate the pathogenesis of the syndrome.