DRUGS AS ALLERGENS FOR CHILDREN: SERUM SICKNESS
An allergic reaction to an injection of horse serum can produce serum sickness. It occurs in 10 percent of children if only 10 cc. of serum are injected, while the incidence rises to 90 percent if 100 cc. are injected. The symptoms are hives, swelling of the joints, and fever. These may appear immediately after an injection, be delayed, or be accelerated. An immediate reaction appears minutes after an injection; a delayed one appears hours after an injection; an accelerated one appears days after the injection.
If a child has had any one of these reactions, a skin test for the serum that has caused the reaction is unnecessary and dangerous. However, if a previous injection went by without a reaction, a skin test for the serum is necessary before giving it again.
In case a child must take a tetanus shot and he is known to be allergic to horse serum, then a human serum which is rich in the same kind of antibodies has to be given to him instead. This serum is to be injected intramuscularly as one single dose. Although human serum has never caused an allergic reaction, this remains a possibility. To avoid it, active ‘immunization against tetanus with toxoids is mandatory to eliminate the need for any tetanus immune serum.
Special precautions are necessary to immunize an egg-sensitive atopic child against influenza, measles, rubella, and mumps vaccines because these vaccines contain egg. (However, if the child has hives or asthma after eating eggs, then no egg vaccine is to be given to him).
Flu vaccination must be given in three doses—the second one two weeks after the first, and the third two months after the second, starting in September and going into December. The vaccine used has to be free from alum, be polyvalent, contain the Asian flu virus, and be given intracutaneously in one-tenth of the regular dose.
While giving the atopic child any kind of immunization, a pediatrician should have adrenalin on hand for unforeseen reactions.
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