Links checked 02/11/18.
Sweet’s syndrome triggered by vaccination.
There is some medical evidence to show that certain vaccinations can potentially trigger Sweet’s syndrome, but this is very rare, and it’s important to take the following information into consideration:
- Sweet’s syndrome is rare, probably affecting no more than 3 people per 10,000 (Zamanian and Ameri, 2007).
- It mainly affects adults not children and only 5% to 8% of cases have been in children (Sharma et al, 2015).
- In some people, something is needed to trigger the onset of Sweet’s syndrome, but in 50% of people with Sweet’s syndrome there is no known trigger.
- Infection is a more common trigger for Sweet’s syndrome than vaccination, and as a result, Sweet’s syndrome tends to be more common in countries where people have an increased likelihood of developing infections (Ginarte and Toribio, 2011: 120). It’s most commonly triggered by upper respiratory tract infection, but can be triggered by other infections too.
- There have only been 11 cases of Sweet’s syndrome triggered by vaccination reported in medical literature in the past 42 years, globally. In some of these cases, a definite connection between the vaccination and Sweet’s syndrome was not established.
- Sweet’s syndrome has only been associated with certain vaccinations and not others (see below).
Which vaccinations have been associated with Sweet’s syndrome?
Sweet’s syndrome has been associated with the following vaccinations:
- Bacillus Calmette-Guerin, live attenuated (modified and weakened) vaccine (BCG or tuberculosis) (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases. One in 1986, occurring 15 days after vaccination, but the authors of the medical article that reported this did not control the tuberculin (Mantoux) test. One reported in 2002, occurring 10 days after vaccination.
- Hepatitis B, inactivated (killed) vaccine (Enokawa et al, 2017). One case in a 69-year-old man with the autoimmune condition, systemic lupus erythematosus. Symptoms of Sweet’s syndrome started to develop 48 hours after vaccination, and there were no lesions at the vaccination site.
- Influenza injection, inactivated (Cruz-Velasquez et al, 2016; Hali et al, 2010, Jovanovic et al, 2005; Tan el al. 2006; Wolf et al. 2009). Four cases. One reported in 2005; in 2006, one case of bullous Sweet’s syndrome following vaccination in a HIV-infected patient; in 2009, neutrophilic dermatosis of the hands occurring 12 hours after vaccination; in 2010, one case of Sweet’s syndrome after H1N1 influenza (swine flu) vaccination. Additional note: in the UK, children receive the nasal spray flu vaccine which is a live attenuated vaccine, but there are no cases of Sweet’s syndrome being triggered by it.
- Smallpox, a live vaccine that contains a pox-type virus related to smallpox, but causes a milder disease (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases reported in 1975, occurring 3 days after vaccination.
- Streptococcus pneumonia, inactivated (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016; Pedrosa et al, 2013). Two cases. One reported in 1990, occurring 4 days after vaccination following a splenectomy. One reported in 2013, and the first with the 13-valent conjugate vaccine.
Do vaccinations trigger Sweet’s syndrome because they are toxic or contain dangerous chemicals?
No. Vaccinations do not trigger Sweet’s syndrome because they are toxic or contain dangerous chemicals, and anyone who tells you this may be doing so for one of the following reasons: they have no real understanding of vaccination or Sweet’s syndrome; they are trying to scare you; they are trying to promote an anti-vax agenda; they are trying to sell you something, e.g. ‘detox’ products that will supposedly cleanse your body of vaccine ‘toxins’, and thereby, cure your Sweet’s syndrome.
Why do vaccinations trigger Sweet’s syndrome?
Vaccination can trigger Sweet’s syndrome because of hypersensitivity reaction.
What is hypersensitivity reaction in Sweet’s syndrome?
In Sweet’s syndrome, the innate immune system – the body’s most primitive ‘hard-wired’ immune system and a part of the immune system that doesn’t produce antibodies – doesn’t always work in the way that it should. Because of this, in some people with Sweet’s syndrome, their innate immune system may respond to antigens in a way that it shouldn’t, i.e. is hypersensitive and overreacts or responds in the wrong way to the presence of infectious, inflammatory, drug, or tumour cell antigens (Bhat et al, 2015: 257; Kasirye et al, 2011: 135).
Antigens are mainly proteins or sugars on the surface of a cell or a non-living substance, that a part of your immune system called the adaptive immune system sees as a foreign invader and produces antibodies in response to. The presence of antigens associated with certain health conditions, medications and vaccinations can potentially trigger Sweet’s syndrome by stimulating the innate immune system to produce molecular messengers called cytokines, which eventually leads to the activation of white blood cells called neutrophils (Gosheger et al, 2002: 70). The neutrophils migrate to skin tissues and sometimes other tissues, causing skin lesions or other symptoms of Sweet’s syndrome.
If I have Sweet’s syndrome should I avoid having vaccinations?
No. Most people with Sweet’s syndrome don’t need to avoid having their vaccinations unless they can’t be vaccinated for other reasons, e.g. they are taking certain types of medication, have other health conditions, or the doctor is being cautious because their Sweet’s syndrome is severe and very difficult to manage (this normally only applies to the flu vaccination, the commonest vaccine trigger). However, if the Sweet’s syndrome was initially triggered by a particular vaccination, then it would not be advisable to have the same kind of vaccination again.
How do I know if vaccination has triggered my Sweet’s syndrome?
Remember, Sweet’s syndrome triggered by vaccination is very rare, but if it does happen then symptoms usually develop within hours or days, less commonly, a few weeks after vaccination. Skin lesions sometimes appear at the vaccination site, but this can also happen because of the skin damage caused by having the vaccination (puncture wound from the needle) rather than the vaccine itself. This response is known as pathergy.
Are there other triggers for Sweet’s syndrome?
Yes, and aside from the triggers that have already been mentioned (infection, skin damage, and vaccination), other triggers for Sweet’s syndrome include:
- Cancer in approximately 20% of cases, one of the most common being a group of blood disorders called myelodysplastic syndromes (Chen et al, 2016).
- Inflammatory bowel disease, e.g. Crohn’s disease and ulcerative colitis (Cohen, 2007).
- Autoimmune conditions, e.g. rheumatoid arthritis and systemic lupus erythematosus.
- Medications in 12% of cases.
- Pregnancy in up to 2% of cases.
- Overexposure to sunlight or ultraviolet light.
Bhat, Y., Hassan, I., Sajad, P., Akhtar, S. and Sheikh, S. (2015) Sweet’s Syndrome: An Evidence-Based Report. Journal of the College of Physicians and Surgeons – Pakistan, Jul;25(7):525-7 (PubMed).
Carpentier, O., Piette, F. and Delaporte, E. (2002) Sweet’s syndrome after BCG vaccination. Acta Dermato-Venereologica;82(3):221 (PubMed).
Chen, S., Kuo, Y., Liu, Y., Chen, B., Lu, Y. and Miser, J. (2016) Acute Myeloid Leukemia Presenting with Sweet Syndrome: A Case Report and Review of the Literature. Pediatrics and Neonatology (online).
Cohen, P. (2007) Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis (BMC).
Cruz-Velásquez, G., Pac Sha, J., Simal Gil, E. and Gazulla, J. (2016). Aseptic meningitis and anti-β2-glycoprotein 1 antibodies in Sweet syndrome. Neurologia (Barcelona, Spain), Jul 21 (Elsevier). Article in Spanish, use translate.
Enokawa, M., Giovanella, L., Zardo, B., Cunha, J., Rachid Filho, A., Zeni, L., Bisognin, M., Rosseto, C. and Guimaraes, A. (2017) Sweet’s Syndrome Discharged (Caused) by Hepatitis B Vaccine. Brazilian Journal of Rheumatology, 57(suppl 1):S197 (Science Direct). Article in Portuguese, use translate.
Ginarte, M. and Toribio, J. (2011) Sweet Syndrome. In Dr. Fang-Ping (Ed.) Autoimmune Disorders – Current Concepts and Advances from Bedside to Mechanistic Insights. Croatia or China: Intech, pp. 119-132 (PDF).
Gosheger, G., Hillman, A., Ozaki, T., Buerger, H. and Winklemann, W. (2002) Sweet’s Syndrome Associated With Pigmented Villonodular Synovitis. Acta Orthopædica Belgica, Feb;68(1):68-71 (PubMed).
Hali, F., Sbai, M., Benchikhi, H., Ouakadi, A. and Zamiati, S. (2010) [Sweet’s syndrome after H1N1 influenza vaccination]. Annales de Dermatologie et de Venereologie, Nov;137(11):740-1 (PubMed).
Jovanovic, M., Poljacki, M., Vujanovic, L. and Duran, V. (2005) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) after influenza vaccination. Journal of the American Academy of Dermatology, Feb;52(2):367-9 (PubMed).
Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).
Pedrosa, A., Morais, P., Nogueira, A., Pardal, J. and Azevedo, F. (2013) Sweet’s syndrome triggered by pneumococcal vaccination. Cutaneous and Ocular Toxicology, Sep;32(3):260-1 (PubMed).
Sharma, A., Rattan, R., Shankar, V., Tegta, G. and Verma, G. (2015) Sweet’s syndrome in a 1-year-old child. Indian Journal of Paediatric Dermatology;16:29-31 (online).
Tan, A., Tan. H., and Lim, P. (2006) Bullous Sweet’s syndrome following influenza vaccination in a HIV-infected patient. International Journal of Dermatology, Oct;45(10):1254-5 (PubMed).
Zamanian, A. and Ameri, A. (2007) Acute febrile neutrophilic dermatosis (Sweet’s syndrome): a study of 15 cases in Iran. International Journal of Dermatology, Jun;46(6):571-4 (PubMed).
Wolf, R., Barzilai, A. and Davidovici, B. (2009) Neutrophilic dermatosis of the hands after influenza vaccination. International Journal of Dermatology, Jan;48(1):66-8 (PubMed).
2012-present, Sweet’s Syndrome UK