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Large local reaction to influenza shot11/4/2009
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10 y/o who in 2001 had a quarter size local after influenza immunization. After 2002 immunizationabout 6 hrs later large local to about elbow and temp of 102.Later that night temp went to 104.Went to hospital with Dx cellutitis and got IV antibiotic and cultures were reported as neg. Local lasted about 4 more days. and gradually resolved.Never had generalized hives or angioedema or other Sx. No further influenza shots. But wants one now.
Question what type of reaction was this, how to work this up and can he get the flu shot?
In particular was this an Arthus reaction? Does he need to be pre treated ie antihistamines, steriods? Doesn't seem to be IGE reaction?? Should I still skin test to vaccine? No allergy to egg! Due to flu problems in Milw mom wants the injection next WED.
Thanks for help. |
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Thank you for your recent inquiry.
Unfortunately, I am afraid I cannot tell you the mechanism of production of the reaction. We can only hypothesize. Certainly an Arthus would be considered as well as an early and late phase IgE skin test response. However, from a practical standpoint,regarding the administration of the vaccine, I would suggest the following:
Give a "test shot" of 0.05 cc intramuscularly. If no reaction occurs, I would bring him back 24 hours later and give a second dose of 0.1 cc. If no reaction occurs, I would bring back and give a third injection of 0.2 cc 24 hours later. Finally, if still no reaction, I would administer another 0.2 cc injection after 24 more hours.
We quite often perform this type of challenge in people who have reported unusual adverse responses to influenza vaccine. If, of course, a large local reaction during any of the injections occurred, you may wish not to pursue the challenge further.
We usually do not pre-treat with and medications.
Finally, we would greatly appreciate a follow-up from you if you decide to pursue the graded challenge as described above.
Thank you again for your inquiry and we hope this response is helpful to you.
Sincerely,
Phil Lieberman, M.D.
7205 Wolf River Boulevard, Suite 200
Germantown, TN 38138
Telephone: 901-757-6100
Fax: 901-757-6109
PL:kl
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