[Anaphylactic reactions following active tetanus immunization]

Detection of tetanus antitoxin using Eu(3+)-labeled anti-human immunoglobulin G monoclonal antibodies in a time-resolved fluorescence immunoassay

Tetanus antitoxin in human sera was detected with solid-phase immunoassays in microtitration modules coated with tetanus toxoid by using Eu(3+)-labeled anti-human monoclonal antibodies on the basis of an exactly calibrated antibody standard. The use of a time-resolved fluorescence immunoassay (TR-FIA) significantly improved the quantitative detection of tetanus antitoxin over that of the enzyme-linked immunosorbent assay (ELISA) technique because of its high sensitivity and its wide measurement range, detecting antibody levels between 0.001 and 12.5 IU/ml with a single serum dilution of 1:100. For the same purpose, two different serum dilutions (1:100 and 1:1,000) were needed in the ELISA technique. TR-FIA is reproducible and can be performed in 3.5 h. A study of 2,630 serum samples was undertaken to examine the age-dependent distribution of titer levels, indicating the decline of sufficient protection in patients older than 60 years. The wide measurement range of TR-FIA enabled fast examination of large numbers of serum samples without the need for repetition, with further sample dilution, as was often necessary in the ELISA procedure.

[Tetanus vaccination--tolerance and prevention of side effects]

Data collected over a 15-year period concerning the side effects directly reported following administration of Tetanol were evaluated and it was found that the tetanus vaccination exhibited an extremely high degree of tolerance, with only 27 cases of side effects for 1 million doses. In over 80% of those cases with side effects the intolerance took the form of a painful reddening and/or swelling at the site of injection. This reaction to the vaccination, though not uncommon, was thus greater than is to be expected. General reactions, particularly malaise and an increase in body temperature, accounted for 10% of the cases reported; 3% involved skin reactions beyond the injection site. Symptoms involving the cardiac, circulatory, respiratory, locomotor, or nervous system occurred in fewer than 3 cases per 1 million doses, i.e., in fewer than 5% of the reported cases. It proved highly improbable that an allergic-anaphylactic or anaphylactoid reaction was involved and the complete picture of anaphylactic shock was never observed. Young and middle-aged adults with several tetanus pre-vaccinations accounted for the majority of side effects reported and in most cases hyperimmunization was suspected as a cause. As they were mainly restricted to the site of application and in 75% of cases occurred within 2-48 h, they can be interpreted as type III reactions (Arthus type). Furthermore it can be assumed that other causes of the reactions will have included unintentional intravascular and subcutaneous administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoglobulin E-suppressing and immunoglobulin G-enhancing tetanus toxoid prepared by conjugation with pullulan

Immunoglobulin E (IgE) antibody response was found to be suppressed selectively and antigen specifically in mice given an antigen conjugated with pullulan, a linear copolymer of maltotriose, whereas IgM and IgG antibody responses were enhanced. On the basis of this finding, tetanus toxin was conjugated with pullulan by cyanuric chloride in the hope that the toxin would be detoxified by the conjugation procedure and could be used as an IgE-suppressing and IgG-enhancing toxoid without the aid of an aluminum adjuvant. This procedure of tetanus toxoid-pullulan conjugation apparently detoxified the toxin. Administration of the resulting tetanus toxoid, tetanus toxin-pullulan conjugate, to mice induced strong suppression of IgE antibody response with fairly good IgG response, whereas the alum-precipitated toxoid or plain toxoid, customarily used for vaccination, elicited high IgE antibody formation. The IgE antibody response was minimal, but the IgG antibody response was maximal in the conjugate-primed mice even after a booster injection with an IgE antibody-inducing dose of the alum-precipitated toxoid.