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Can Allergy Shots Cause Muscle And Joint Pain?

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Posted on Mon, 17 Oct 2016
Question: Can allergy shots trigger muscle/joint pain in the ankles, wrists, knees, back, and calves? My 8 year old daughter has had 5 shots and these symptoms started shortly after her second or third shot. She also had an episode of high fever, vomiting and flu like symptoms a few weeks after her joint pain started. The pediatrician claimed it was due to strep (not in her throat) and started her on augmentin for two weeks, which took care of her fever and malaise immediately but did not cure her joint and muscle aches. I am wondering if the aches are due to the introduction of allergy shots 6 weeks ago? Or are they more likely related to strep? What bloodtest markers would be recommended to get a definitive answer as to the cause?
If the aches are due to strep, how long should it take to cease? And if the aches are due to allergy shots, will antihistamines help prevent or stop them?
If the one day episode of 103 fever, vomiting, and fatigue was improved within 12 hrs after starting augmentin, is it more likely that she had strep? If yes, is it normal that the aches are still going on after 1 1/2 weeks on antibiotics?
If due to strep, would procalcitonin levels still be elevated even on antibiotics, making it a useful diagnostic tool as to the cause?
Spoke with her allergist who claims he has never had a patient doing allergy shots that experienced muscle aches.

doctor
Answered by Dr. Sumanth Amperayani (4 hours later)
Brief Answer:
Suggestions on allergy shots and streptococcal related joint pains

Detailed Answer:
Hi... I understand your concern.

Coming to your queries -

1. Allergy shots can trigger muscle/joint pain in the ankles, wrists, knees, back, and calves. But it is very very unusual and rare to occur as a late response like what you are describing. usually it will be an immediate response to the allergy shot.

2. Streptococcal sore throat causing joint symptoms is called rheumatic fever. But in this the fever sore throat will precede the joint pain by 2-3 weeks. But here in your case the joint symptoms started first followed by sore throat. So it is unlikely to be due to streptococcal. Moreover only streptococcal sore throat or pharyngitis can cause rheumatic fever and not any other streptococcal infection.

3. If it is due to strep - ASO titre raising four fold in 4 weeks can give you an answer. Even a single titre of more than 300 can be corroborative evidence.

4. Aches due to strep will have dramatic response to NSAID or pain killer drugs like Ibuprofen or Aspirin. Pain due to allergy shots is rare and there is no literature evidence to say in how many days it will settle (as the condition itself is questionable).

5. Fever going off immediately after Augmentin can be a corroborative evidence of strep infection but not confirmatory. It can even be a viral illness. To be sure about strep - a rapid streptococcal antigen test should have been done along with a throat swab culture. If it is positive then the kid will require antibiotics. If it is negative then it might be viral illness and doesn't require antibiotics at all.

6. Even if it is strep infection the duration of antibiotics is only 10 days and not 1.5 weeks.

7. In acute situations I would depend on Procalcitonin. But in such long standing inflammation like this Procalcitonin is likely to be elevated as it is basically an inflammatory marker.


The possibilities I put forth are -

1. Viral illness induced joint pains and muscle pains.
2. Connective disorder like polyarticular rheumatoid arthritis or SLE.
3. Chronic fatigue syndrome.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Regards - Dr. Sumanth MBBS., DCH., DNB (Paed).,

Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Sumanth Amperayani (23 hours later)
Thank you. Just wanted to clarify that she never experienced sore throat and a throat culture (not 24 hr just immediate) was done and was negative. she was started on antibiotics anyway. In your opinion, if there was no strep throat, it could not have been strep (located elsewhere) induced joint pain at all?

And if her fever and vomiting were a virus, that could cause joint pain persisting for longer than six weeks?
doctor
Answered by Dr. Sumanth Amperayani (5 minutes later)
Brief Answer:
Streptococcal infection in throat alone can cause joint pain

Detailed Answer:
Hi... Coming to your queries directly -

1. Only streptococcal infection in throat can cause joint pain. Streptococcal infection elsewhere cannot cause joint pain.

2. Yes, viral illness can cause prolonged joint pain like this.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 8341 Questions

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Can Allergy Shots Cause Muscle And Joint Pain?

Brief Answer: Suggestions on allergy shots and streptococcal related joint pains Detailed Answer: Hi... I understand your concern. Coming to your queries - 1. Allergy shots can trigger muscle/joint pain in the ankles, wrists, knees, back, and calves. But it is very very unusual and rare to occur as a late response like what you are describing. usually it will be an immediate response to the allergy shot. 2. Streptococcal sore throat causing joint symptoms is called rheumatic fever. But in this the fever sore throat will precede the joint pain by 2-3 weeks. But here in your case the joint symptoms started first followed by sore throat. So it is unlikely to be due to streptococcal. Moreover only streptococcal sore throat or pharyngitis can cause rheumatic fever and not any other streptococcal infection. 3. If it is due to strep - ASO titre raising four fold in 4 weeks can give you an answer. Even a single titre of more than 300 can be corroborative evidence. 4. Aches due to strep will have dramatic response to NSAID or pain killer drugs like Ibuprofen or Aspirin. Pain due to allergy shots is rare and there is no literature evidence to say in how many days it will settle (as the condition itself is questionable). 5. Fever going off immediately after Augmentin can be a corroborative evidence of strep infection but not confirmatory. It can even be a viral illness. To be sure about strep - a rapid streptococcal antigen test should have been done along with a throat swab culture. If it is positive then the kid will require antibiotics. If it is negative then it might be viral illness and doesn't require antibiotics at all. 6. Even if it is strep infection the duration of antibiotics is only 10 days and not 1.5 weeks. 7. In acute situations I would depend on Procalcitonin. But in such long standing inflammation like this Procalcitonin is likely to be elevated as it is basically an inflammatory marker. The possibilities I put forth are - 1. Viral illness induced joint pains and muscle pains. 2. Connective disorder like polyarticular rheumatoid arthritis or SLE. 3. Chronic fatigue syndrome. Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health. Regards - Dr. Sumanth MBBS., DCH., DNB (Paed).,