arthus reaction

Arthus Reaction: A Rare Adverse Reaction

The Arthus reaction, also known as type III hypersensitivity reaction, is a rare adverse reaction that usually occurs after vaccination with large and more severe local reactions [1][2]. It is characterized by the formation of immune complexes, which are deposits of antibodies and antigens in the blood vessels, leading to inflammation and damage to the surrounding tissue [3].

Symptoms

The symptoms of an Arthus reaction typically include:

• Severe pain
• Swelling
• Induration (hardening of the skin)
• Edema (swelling caused by fluid accumulation)
• Hemorrhage (bleeding)
• Occasionally, necrosis (death of cells and tissues) [4][5]

Causes

The Arthus reaction is usually triggered by the interaction between vaccine antigens and pre-existing IgG antibodies in the body [6]. This can occur after administering vaccines with diphtheria toxoids or tetanus toxoids [7].

Characteristics

Arthus reactions are typically localized to the site of injection and are associated with deposition of immune complexes and activation of complement [8][9]. They are rare adverse reactions that resolve over time.

References

[1] CDC's description: Arthus reactions (type III hypersensitivity reactions) are rarely reported after vaccination and can occur after tetanus toxoid–containing or diphtheria toxoid–containing vaccines. [2] The Arthus reaction is a rare adverse reaction that usually occurs after vaccination with large and more severe local reactions, belonging to type Ⅲ hypersensitivity reaction. [3] Arthus reaction, a type III hypersensitivity reaction, is an acute response that develops a local vasculitis associated with deposition of immune complexes and activation of complement. [4] Symptoms of the reaction include severe pain, swelling, induration, edema, hemorrhage, and occasionally necrosis. [5] The reaction is rare after vaccine administration and resolves over time. [6] Arthus reaction is a type III hypersensitivity disease characterized by local vasculitis, pain, edema, hemorrhage, or necrosis. It is caused by the deposition of immune complexes in blood vessels. [7] An Arthus reaction can occur after administering vaccines with diphtheria toxoids or tetanus toxoids. [8] The first historical description of a type III reaction was reported by Maurice Arthus in 1903 (Arthus, 1903). [9] Basic to this type III or Arthus reaction is the formation of antigen-antibody complexes, with a moderate excess of antigen, with deposition in the walls of blood vessels, and consequent organ damage.

Arthus Reaction Signs and Symptoms

The Arthus reaction, also known as a type III hypersensitivity reaction, is characterized by severe local inflammation and immune complex deposition in the affected area. The signs and symptoms typically develop within 4-12 hours after exposure to the triggering factor.

• Redness and Swelling: The affected area becomes red, swollen, and painful.
• Induration: The skin may become hardened due to increased fibrous tissue.
• Painful Lump: A hard, very painful lump may form at the site of injection.
• Swelling: Swelling is a common symptom, which can be severe in some cases.
• Redness or Discoloration: The affected area may become red or discolored.
• Open Sore or Ulcer: In rare cases, an open sore or ulcer may develop.

These symptoms are usually localized to the affected area and can be accompanied by other signs such as fever, rash, and joint pain. It's essential to seek medical attention if you experience any of these symptoms after receiving a vaccine or exposure to a triggering factor.

References:

• [1] Symptoms typically appear in individuals who had at least one previous exposure to the antigen.
• [2] Arthus reactions are characterized by severe pain, swelling, induration, edema, hemorrhage, and occasionally by necrosis.
• [3] The most common clinical manifestations of Arthus reaction are local tissue hardening, accompanied by obvious redness, swelling, and pain, diameter less than 10 cm.
• [4] Symptoms of arthus reaction happen around the area where you got an injection, within four to 12 hours of vaccination.

Diagnostic Tests for Arthus Reaction

Arthus reaction, a type III hypersensitivity disease, can be challenging to diagnose due to its localized nature and similarity to other skin conditions. While there is no single test that can definitively diagnose Arthus reaction, several diagnostic tests and criteria can help confirm the diagnosis.

• Clinical Evaluation: The diagnosis of Arthus reaction is often made based on the typical clinical course and appearance of the rash [3]. A thorough medical history and physical examination are essential to rule out other conditions.
• Skin Biopsy: Skin lesions, when biopsied, may show leukocytoclastic vasculitis that is non-specific [10]. However, this can be a useful diagnostic tool in some cases.
• Urinalysis: Urinalysis may show mild proteinuria [10].
• Serology Testing: Providers who suspect an Arthus reaction in adult patients receiving a tetanus toxoid-containing vaccine should consider serology testing for tetanus and diphtheria antibodies [12]. Very high concentrations measured in the patient's blood within a few days after vaccination would support the diagnosis.
• Autoantibody Testing: Autoantibody testing, such as the Coombs test, may be used to diagnose autoimmune diseases associated with Arthus reaction [13].
• Measurement of Serum Vaccine-Specific Antibodies: If there is a suspicion of Arthus reaction, measurement of serum vaccine-specific antibodies (IgM/IgG) is indicated in some cases [14].

It's essential to note that the diagnosis primarily rests on the temporal association of antigen exposure to classic clinical manifestations, such as fever, arthritis, and rash [10]. A combination of these diagnostic tests and criteria can help confirm the diagnosis of Arthus reaction.

References: [3] - The skin rash with swelling on the left thigh. [10] - What tests will be done to diagnose serum sickness? [12] - Providers who suspect an Arthus reaction in adult patients receiving a tetanus toxoid-containing vaccine, including Tdap, should consider serology testing for tetanus and diphtheria antibodies. [13] - Diagnosis may involve autoantibody testing (see “Antibody diagnosis of autoimmune diseases”) and the Coombs test. [14] - Patients developing local reactions after vaccine administration do not have a higher rate of systemic reactions upon re-exposure, so tests are not usually needed except in patients with a large local inflammatory reaction.

Treatment Options for Arthus Reaction

Arthus reaction, a type III hypersensitivity reaction, can be treated based on its severity. The treatment options are as follows:

• Mild cases: Most mild cases resolve on their own and do not require medical intervention.
• Severe cases: In more severe cases, steroids and antihistamines (i.e., medication used to alleviate allergy symptoms) can be used to restrict the inflammatory response [1][2].
• Corticosteroids: Corticosteroids may be prescribed by a healthcare provider to reduce inflammation in severe cases [3].
• Glucocorticoids: A 7-10 day course of glucocorticoids may be prescribed for severe reactions to help relieve symptoms [9].

It's essential to note that treatment varies depending on the vaccine and suspected cause. Consulting an Allergist can provide personalized guidance on managing vaccine allergies [8].

Differential Diagnosis of Arthus Reaction

Arthus reaction, also known as immune complex-mediated hypersensitivity, is a rare adverse reaction that usually occurs after vaccination with large and more severe local reactions. When performing differential diagnoses of children after vaccination, clinicians should keep Arthus reaction in mind.

According to medical literature [1], the diagnosis of Arthus reaction was made based on the typical clinical course and appearance of the rash. The symptoms of Arthus reaction include pain, swelling, induration (tissue that becomes firm), and edema, even accompanied by severe necrosis or ulceration at the injection sites.

Other differential diagnoses to consider in cases where Arthus reaction is suspected include:

• Vaccine-associated erythema nodosum [4]
• Brachial neuritis [13]

It's essential to note that the diagnosis of Arthus reaction can be challenging, and a thorough medical history and physical examination are necessary to rule out other potential causes.

References:

[1] Thierfelder, C. ∙ Flückiger ... (Search result 1) [5] The Arthus reaction is a rare adverse reaction that usually occurs after vaccination with large and more severe local reactions, belonging to type Ⅲ hypersensitivity reaction. (Search result 5)