From the Guidelines
The Arthus reaction is a type III hypersensitivity reaction characterized by local vasculitis, immune complex deposition, and complement activation, typically occurring 4-12 hours after vaccination with symptoms of severe pain, swelling, induration, edema, hemorrhage, and occasionally necrosis. This reaction is associated with the formation of immune complexes in the setting of high local concentration of vaccine antigens and high concentration of circulating antibody 1. The symptoms and signs of an Arthus reaction usually resolve without sequelae, but it is essential to recognize and manage this condition to prevent potential complications.
Key Characteristics
- Localized type III hypersensitivity reaction
- Occurs 4-12 hours after vaccination
- Characterized by severe pain, swelling, induration, edema, hemorrhage, and occasionally necrosis
- Associated with immune complex deposition and complement activation
- Typically resolves without sequelae
Clinical Presentation
- Painful, red, and swollen area at the site of antigen introduction
- May progress to tissue damage if severe
- Distinct from immediate hypersensitivity reactions (type I) in its delayed onset and mechanism
Management
- Removing the offending antigen if possible
- Symptomatic treatment with anti-inflammatory medications
- Avoiding repeated exposure to the offending antigen, such as tetanus toxoid–containing vaccines, more frequently than every 10 years in individuals who have experienced an Arthus reaction 1.
From the Research
Definition and Characteristics of Arthus Reaction
- 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 2.
- This reaction is characterized by pain, swelling, induration (tissue that becomes firm) and edema, even accompanied by severe necrosis or ulceration at the injection sites 2.
- The Arthus reaction is a model of immune-complex-induced tissue injury 3.
Causes and Mechanisms of Arthus Reaction
- The specific causes of Arthus reaction after one dose of vaccination are not described in detail in literatures, but it could be hypothesized that the case has a pre-existing specific IgG to cause the Arthus reaction 2.
- Antibody-antigen complexes initiate the inflammatory response and are central to the pathogenesis of tissue injury 4.
- Fc receptors initiate the Arthus reaction, and immune complex-triggered inflammation is initiated by cell-bound Fc receptors and is then amplified by cellular mediators and activated complement 4.
- P-selectin plays an important role in the pathogenesis of the Arthus reaction, especially in the early stage, by recruiting neutrophils into sites of inflammation 5.
Clinical Symptoms and Treatment
- The clinical symptoms of Arthus reaction include redness, swelling, and painful itching at or around the injection sites 2.
- Most mild cases of Arthus reaction can be cured without treatment, and only severe cases need to be treated with anti-allergy medication 2.
- Hydrocortisone and colchicine were found to be strong inhibitors of the Arthus reaction, with calculated ED50 values of 13 mg/kg p.o. and 0.3 mg/kg i.v., respectively 3.
Epidemiology and Risk Factors
- Only 30 cases of Arthus reaction were found in a literature search, with 17 reported cases in children younger than 6 years old 2.
- The proportion of Arthus reaction occurred after the first, second, and third injections in case reports was 13.3%, 50.0%, and 23.3%, respectively 2.
- There are no other data on the total number and incidence rate of vaccination, so statistically significant differences cannot be compared 2.