[Note 1] Probable Anaphylactic Reaction
ÎÎReaction occurring within 4 hours of vaccine administration to include
signs and/or symptoms from more than 1 of the following systems:
>> Dermatologic: urticaria, flushing, angioedema, pruritus
>> Respiratory: rhinoconjunctivitis (red, watery, itchy eyes; stuffy, runny, itchy nose,
sneezing), upper airway edema (change in voice, difficulty swallowing, difficulty
breathing), bronchospasm/asthma (cough, wheeze, shortness of breath, chest
tightness)
>> Cardiovascular: hypotension, tachycardia, palpitations, light-headedness, loss of
consciousness
Comment: hypotension or loss of consciousness with pallor and bradycardia is much
more likely a vasovagal reaction.
>> GI: cramping, nausea, vomiting, diarrhea
ÎÎPossible Anaphylactic Reaction:
>> Signs and/or symptoms from only 1 system (as above)
>> Signs and/or symptoms from more than 1 system (as above) but occurring more than
4 hours after vaccination
[Note 2] Vaccine Skin Tests
ÎÎPrick test with full strength vaccine (consider dilution if history of lifethreatening reaction)
ÎÎIf prick test with full strength vaccine is negative, intradermal test with
0.02 cc vaccine 1:100
Comment: Vaccine skin tests may cause false (or clinically irrelevant) positive reactions.
ÎÎVaccine component/food skin prick tests:
>> Influenza: whole egg or egg white
>> Yellow fever: whole egg or egg white, chicken & gelatin
>> Hepatitis B vaccine and Human Papillomavirus: Saccharomyces cerevisiae yeast
>> DTaP (some brands), influenza (some brands), Japanese encephalitis, measles, mumps,
rabies (some brands), rubella, varicella, zoster: gelatin
Comment: sugared gelatin (eg, Jell-O®: dissolve 1 teaspoon (5 grams) of gelatin powder in
5 cc normal saline)
[Note 3]
ÎÎIf fewer than the recommended number of doses received, consider
measuring level of IgG antibodies to immunizing agent. If at a level
associated with protection from disease, consider withholding additional
doses although magnitude and duration of immunity may be less than if
all doses received.
[Note 4]
ÎÎVaccine administration in graded doses:
>> For a vaccine where usual dose is 0.5 mL, administer graded doses of vaccine at 15
minute intervals: 0.05 mL of 1:10 dilution, 0.05 mL of full strength, 0.10 mL of full
strength, 0.15 mL of full strength, 0.20 mL of full strength.
>> For influenza vaccine in egg-allergic patients, if the egg protein content of the vaccine
is known to be ≤ 1.2 mcg/mL, administer 10% of the dose, followed in 30 minutes by
3
the remaining 90%, or as a single dose.
