[Allergic and non-allergic hypersensitivity reactions to toxoid-containing vaccines].
Most allergic (like) reactions to vaccines are reported in patients immunized with diphtheria and tetanus toxoid-containing vaccines. Local inflammatory reactions are the most frequent, but most of them are non-specific. Diagnosis of Arthus-type reactions is based on clinical history and specific IgM/IgG anti-toxoid determination. For other local reactions (persistent nodules, sterile abscesses, etc.), diagnostic value of non-immediate responses in skin tests varies with clinical symptoms and substances involved. Immediate responses in skin tests and specific antibody determination have good diagnostic and/or predictive value in anaphylaxis and immediate and accelerated urticaria and angioedema. Although a few generalized non-immediate reactions may result from toxoid-specific semi-late or delayed-type hypersensitivity, most reactions are non-specific. Withholding booster injections is advised if specific IgM/IgG levels are high. If the levels are low, sequential intramuscular injections of mono- or paucivalent vaccines are usually tolerated. However, injections of the vaccine should be performed using a "desensitization" procedure in patients reporting anaphylaxis and immediate or accelerated urticaria or angioedema.
Ponvert
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Service de pneumologie et allergologie, département de pédiatrie, groupe hospitalier Necker-Enfants-Malades, 75015 Paris, France. claude.ponvert@nck.aphp.fr
D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D014121:Toxoids / Q000009:adverse effects*; D014611:Vaccination / Q000009:adverse effects*
D014121:Toxoids