Tetanus toxoid has been in use for several decades and has proven its effectiveness and safety. However, a few immediate and delayed reactions have been observed.
Local reactions after booster injections:
pain - tenderness: 50 -85%
erythema-edema: 20 - 30%
marked swelling: 2%
abscess: 6 to 10/million doses.
Previous history of reaction to tetanus toxoid.
Nasal and ophthalmic pruritus.
Cutaneous testing (controversial).
Skin prick tests positive at 1/1000.
Intradermal skin tests positive at 1/10000.
Positive in a few patients with anaphylaxis. False positive and negative are frequent.
Specific IgE (controversial)
Positive in patients with anaphylaxis but:
50% of infants develop specific IgE antibodies after vaccination.
25% of subjects receiving tetanus booster injections have substantial IgE antibodies.
IgE response to tetanus toxoid is higher in atopic children.
Detection of circulating immune complexes in patients with vasculitis.
IgE-mediated hypersensitivity: exceedingly rare.
Type III reaction (hyperimmunization): there is correlation between circulating tetanus toxoid IgG levels and the degree of local reaction.
Do not overlook the role played by thimerosal and aluminum hydroxide in some reactions.
Obtain an antitetanus IgG titer to verify the need for a booster.
Use a tetanus toxoid formulation with a different preservative.
Use an isolated tetanus toxoid which has less reactogen than associations (diphtheria/ tetanus)
Desensitization has been reported to be effective.
1 0.02 cc 1/1 000 ID
2 0.02 cc 1/100 ID
3 0.02 cc 1/10 SC
4 0.10 cc 1/10 SC At 30 min intervals
5 0.05 cc Full strength SC
6 0.10 cc Full strength SC
7 0.15 cc Full strength SC
8 0.20 cc Full strength SC