Hair loss after routine immunizations
R. P. Wise, K. P. Kiminyo and M. E. Salive
Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Md 20852-1448, USA. wise@a1.cber.fda.gov
CONTEXT: Alopecia is a recognized adverse effect of numerous medications,
but vaccines are not normally considered a cause for unexpected loss of
hair. OBJECTIVE: To describe case reports of hair loss after routine
vaccines and to assess the hypothesis that vaccinations might induce hair
loss. DESIGN: Case series with telephone follow-up. METHODS: Review of
spontaneous reports to the Food and Drug Administration, the Centers for
Disease Control and Prevention, and the Vaccine Adverse Event Reporting
System. MAIN OUTCOME MEASURE: Loss of hair following immunization. RESULTS:
A total of 60 evaluable reports submitted since 1984 and coded for
"alopecia" after immunizations included 16 with positive rechallenge (hair
loss after vaccination on more than 1 occasion), 4 of which were definite
and 12 possible or probable. Of the 60 cases, 46 had received hepatitis B
vaccines. Both of the currently available recombinant products, as well as
the former plasma-derived product, were represented. Females predominated
in all age groups. The majority of patients recovered, but clinical
features, such as intervals from vaccination until onset and the extent and
reversibility of hair loss, varied widely. Nine patients reported previous
medication allergy. CONCLUSION: There may be an association, probably very
rare, between vaccinations and hair loss. More than 1 pathophysiologic
mechanism may be responsible. Since apparently nonrandom distributions by
vaccine, age, and sex could reflect biased case ascertainment, further
research will be needed in defined populations with consistent case
detection.
