title: Immediate allergy to tetanus toxoid vaccine: determination of immunoglobulin E and immunoglobulin G antibodies to allergenic proteins.
abstract: BACKGROUND
  Adverse reactions to tetanus toxoid (TT) vaccine are mostly mild and limited to the injection site. However, immunoglobulin (Ig)E-mediated reactions may occur, and the incidence of anaphylactic responses to TT immunization is 0.001%. When TT induces an allergic reaction, the potential causative agents can be TT antigens, thimerosal or aluminum phosphate.
  
  
  OBJECTIVE
  We studied four children who developed immediate urticaria after TT vaccine, soon after the reaction and 5 years later.
  
  
  METHODS
  Skin tests were performed separately with TT vaccine and two vaccine components, thimerosal and aluminum phosphate, and the diagnosis was confirmed by provocation test. IgE and IgG antibodies to TT and their specificities were determined. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting were performed to characterize the antigenic proteins.
  
  
  RESULTS
  All four children were immediate skin test-positive to TT, but negative to thimerosal and aluminum phosphate; 3 developed a reaction after intramuscular provocation using increasing doses of TT vaccine; and 1 refused to be tested. All these tests were negative in five controls, all of whom received TT vaccine and developed only local swelling at the site of application 24 hours after vaccine administration. After 5 years the IgG antibodies were still high in all cases and the IgE antibody values fell by 50%. Patients allergic to TT vaccine produced IgE and IgG antibodies, which decreased at different rates but remained for at least 5 years. The pattern of antibody decrease was confirmed by radioallergosorbent test, enzyme-linked immunoadsorbent assay, or immunoblotting assay. IgE and IgG antibodies recognized two proteins derived from TT, of 150 and 50 kDa, corresponding to the intracellular form and to a chain of the extracellular form of the tetanus neurotoxin.
  
  
  CONCLUSIONS
  In children with immediate allergic reactions to TT vaccine, antibodies may persist for at least 5 years, requiring evaluation by skin and/or in vitro tests before subsequent treatment.
authors.affiliation: Research Unit for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain.
authors.forename: Cristobalina
authors.initials: C
authors.lastname: Mayorga
authors.forename: M José
authors.initials: MJ
authors.lastname: Torres
authors.forename: José Luis
authors.initials: JL
authors.lastname: Corzo
authors.forename: Javier
authors.initials: J
authors.lastname: Alvarez
authors.forename: José Antonio Cornejo
authors.initials: JA
authors.lastname: García
authors.forename: Cristina Antúnez
authors.initials: CA
authors.lastname: Rodríguez
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanca
authors.forename: Antonio
authors.initials: A
authors.lastname: Jurado
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology; D000907:Antibodies, Bacterial / Q000097:blood; D001426:Bacterial Proteins / Q000009:adverse effects* / Q000276:immunology; D001428:Bacterial Vaccines / Q000009:adverse effects*; D002648:Child; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000209:etiology*; D007073:Immunoglobulin E / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D012882:Skin Tests; D013742:Tetanus / Q000517:prevention & control; D013745:Tetanus Toxoid / Q000009:adverse effects*; D014581:Urticaria / Q000209:etiology
chemical_list: D000485:Allergens; D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; D001428:Bacterial Vaccines; D007074:Immunoglobulin G; D013745:Tetanus Toxoid; D007073:Immunoglobulin E