[Note 1] Probable Anaphylactic Reaction
ÎReaction 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 ÎPossible 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
ÎPrick test with full strength vaccine (consider dilution if history of life- threatening reaction)
ÎIf 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. ÎVaccine 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]
ÎIf 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] ÎVaccine 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 the remaining 90%, or as a single dose.
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