Q:

5/8/2014
Patient has a history of large local reaction to Tetanus vaccine which occurred 12-18 hours later. This happened 30 years ago. She would like to get immunised with Tdap vaccine now. She prefers to get it done in one dose. Could you please suggest a steroid pretreatment schedule?

A:

Thank you for your inquiry.

Unfortunately I am not aware of, nor could I find any published protocol, regarding the use of oral corticosteroids for the prevention of large local reactions to tetanus vaccine. Therefore any protocol that I would suggest for you would be purely hypothetical, and there would be no assurance that it would be effective. I might add, parenthetically, that I would not personally suggest a pretreatment protocol with oral corticosteroids in this situation, but would rather proceed with graded injections starting with 0.1 cc and immunize over a three day period (0.1, followed by 0.2, followed by a final dose of 0.2). These could be given every day or every other day since the reaction occurred 12 to 18 hours after the injection. If, however, your patient absolutely refuses that treatment, then you could empirically try 40 mg orally for two days prior to the injection, explaining potential side effects and clearly noting that this therapy may not be effective.

So, in summary, my preference would be to try and convince your patient to take the graded dose challenge which, in my personal experience, has been almost universally successful in permitting the uneventful administration of the vaccine in patients who have had previous local reactions.

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

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology