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initiate an inflammatory reaction involving complement and white blood cells, particularly neutrophils. Tissue sections show acute inflammation, and profound tissue destruction can occur. The most common target organs in an Arthus-type reaction include kidney, skin, joints, lung, and brain (Henson, 1982).

History of Suspected Association with Pertussis Vaccines

Identical twins died 16 and 20 hours after their second DPT shot given at age 10 months (Werne and Garrow, 1946). Autopsy showed evidence of the vascular smooth muscle contraction and increased capillary permeability expected with anaphylaxis. Adverse reactions were not reported in other infants who received the same batch of vaccine. The injected material was sterile. The delayed response was noted to be atypical of the anaphylactic reactions reported to that time. The authors found no cases of anaphylactic reactions to DPT reported in the world's literature.

Evidence from Studies in Humans
Case Reports and Controlled Epidemiologic Studies

Anaphylaxis with shock is uncommon in infancy, but the exact frequency is unknown. Since the original reports in 1946, ''anaphylaxis" (sometimes used less strictly to apply to any type I or immediate hypersensitivity reaction) has been reported in additional infants after routine immunization with DPT. Osvath and colleagues (1979) reported 31 total complications that developed within 36 hours of injection of DPT vaccine into an estimated 300,000 children in Hungary. Five of the 31 reactions were urticaria, which is typically an IgE-mediated response; 7 other infants had severe shock with loss of consciousness (not necessarily allergic in origin) or laryngeal edema, a rate of 2.3 such reactions per 100,000 injections.  Eight of these 12 reactions occurred after the first injection, when specific IgE antibodies would not be expected to be present. (These are not passed from mother to infant across the placenta.) IgG antibodies to antigens in DPT might be present, however.  Serum total IgE levels were considered "moderately elevated" in 29 of the total 31 infants; the 2 babies with normal IgE levels were among those with allergic symptoms. Thus, serum IgE levels were not helpful in considering the possibility of allergy in these patients, and anaphylaxis was not proven.

Pollock and Morris (1983) analyzed data from the North West Thames region of England, where an intensified effort over the previous 7 years had



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