Thank you for your inquiry.
The administration of corticosteroids would be one option. Another option, one in which we usually use in such cases, is to administer the vaccine in graded doses. In our experience, most patients with large local reactions tolerate 0.1 cc administered daily over five days.
To my knowledge, there is no standard procedure, and therefore I would discuss both options with your patient and proceed using one or the other according to her preference and your clinical judgment.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.