Vaccine sensitivity

, / have a patient whom I understand is allergic to tetanus vaccine. Her young daughter was given a 1/10 dosage of tetanus vaccine as a test. She was violently sick within about 10 days and it was some 2 or 3 days before she returned to

normal. In view of the family history the mother

has asked whether it would be wise to immunise

her second child.

Although tetanus is now relatively rare in Britain it remains a serious disease with an appreciable mortality. Most cases follow trivial wounds and children because of the frequency of minor injuries, must be considered at special risk. Every effort should be made to protect them.by immunization. The enquirer is understandably concerned about the risks of immunization because of the family history of sensitivity to tetanus vaccine. It does not necessarily follow, however, that the second child will react in the same way as the first. Nevertheless, it would be sensible to take • precautions against anaphylaxis and the following regimen is suggested.

Provided the child is not sensitive to aspirin an antihistamine together with aspirin should be given orally, in dosage appropriate for age; one hour before the injection of a test dose of vaccine. If there is no disturbance within 20 minutes the full dose of vaccine should be given.'If given before exposure to the allergen, antihistamines are of prophylactic value in type I hypersensitivity reactions and aspirin, by prostaglandin inhibition, is also hejpful in suppressing the effects of histamine, it would be wise to repeat the same regimen when subsequent dosages of vaccine are given.

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