Reaction to tetanus booster unlikely
Dear Dr. Roach: I was told by my doctor that I need a tetanus booster shot, but when I was 17, I cut my foot and needed stitches. I was told then that I was allergic to the tetanus shot, so they gave me penicillin instead. Of course, that was a long time ago, since I’m now 81 years old. How could they have determined I was allergic to the shot, and is that even reliable? Can I be tested now?
Answer: Reactions to vaccines are common, but they were much more common 64 years ago, when the purity of vaccines was far less than what it is now. One reaction that was common in the 1950s is called an Arthus reaction, which causes painful swelling at the injection site within a few hours, the worst swelling usually occuring around 24 hours later. You are unlikely to get that type of allergic reaction because of better vaccines, and because it has been so many years since you’ve taken the vaccine.
Very few people get anaphylactic reactions. Anaphylaxis is a life-threatening condition, which often starts with skin symptoms such as hives or swelling; respiratory symptoms such as nasal congestion, discharge or the sensation of the throat closing; gastrointestinal symptoms such as nausea, vomiting or abdominal pain; and cardiovascular symptoms such as dizziness and fainting. Any history of anaphylaxis prevents you from getting the same trigger (vaccine or medication) again, if it can be helped. Only a careful history of your symptoms at the time of the allergic reaction you had can provide an answer on which type of reaction it was. Blood testing for allergic reactions is not 100% reliable.
If you haven’t had a tetanus vaccine in over 60 years, the decision to give one now really is a judgment call based on your likelihood of exposures. If you do a lot of gardening or hiking, it may be worthwhile to give you a vaccine with careful monitoring. If you were to develop a tetanus-prone wound, such as a deep wound that comes into contact with soil or manure, you would be recommended tetanus immunoglobulin as well as a tetanus vaccine. Penicillin alone is not effective in preventing tetanus: Meticulous wound cleaning is critical, in addition to the shots.