Q:

Is there a protocol for allergy testing to tetanus toxoid?

A:

Thank you for your recent inquiry.

This question was sent to our website and answered in 2008. I have copied the response for you below. In addition, I have copied below a reference for skin testing procedures to the majority of vaccines which was written by Dr. Wood should other instances like this arise in your practice.

Thank you again for your inquiry and we hope this response is helpful to you.

Previous inquiry and response:

How to evaluate a patient with possible allergy to tetanus toxoid

Question:

Is there a way to test for tetanus toxoid? How can I administer tetanus if a patient is allergic?

Answer:

Yes, there is a way to test for tetanus toxoid. The reference for this is:
Grammer LC. In: Patterson's Allergic Disease, Sixth Edition, Page 369, 2002.

The recommendation is to begin with a skin prick test using undiluted toxoid. If the skin test is negative, one would perform an intradermal test. This could be performed with a 1:1,000 concentration. If this test is negative, one could proceed to a 1:100 concentration intradermally. Dilutions can be made with saline.

If a positive test is obtained, one could then begin a "desensitization/challenge," and that procedure is outlined for you in the above reference. This text is readily available, but should you have any difficulty obtaining it, if you will send us your fax number, I will copy the page and fax it to you.

Finally, there is another approach. I assume that the patient in question may require the administration of tetanus toxoid. If, however, they have a protective level of antibody, this may not be necessary. Therefore, you could also consider testing for antitetanus antibody if they have been previously immunized. This is a readily commercially available test and there are cut off points which indicate a protective level of antibody. If this level is protective, the toxoid may not be needed.

Reference:
Wood RA. Allergy Clin Immunol. 2007 Aug;120(2):478-81. Epub 2007 Jun 4.
Irritant skin test reactions to common vaccines

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology