Undiluted toxoid, plain or fluid, (in contradistinction to alum-precipitated toxoid) is now in general use as an active immunizing agent against diphtheria. Its effectiveness is well established. However, reactions to the injections do occur. Presumably, both the effectiveness and the likelihood of reaction increase with the dose. Therefore, one should try to strike a balance, giving that dose which is just not large enough to produce reaction. To help in finding this there are two suggested guides: (1) the age of the subject and (2) the subject's sensitivity to various cutaneous tests performed previous to injection.
The amount of caution that one must exercise in giving injections of toxoid depends on the expected frequency and severity of reaction. However, there is so much variation in the findings1 that one cannot obtain from the literature a clear idea as to the extent of reaction.
Although many investigators have used different
HAYMAN CR. REACTIONS FOLLOWING THE USE OF DIPHTHERIA TOXOID: ANALYSIS OF THE REACTIONS AND OF GUIDES TO THEIR OCCURRENCE. Am J Dis Child. 1938;56(4):723–734. doi:10.1001/archpedi.1938.01980160003001
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