Anaphylactoid and anaphylactic reactions

[Keri__0__0]

  I am currently enrolled in the local EMT program and am required to begin the Hepatitis B vaccine.  Within minutes of receiving the first shot I began to itch.  I was given Benadryl 50 mg, im.,  then epi 0.3 sq., decadeon 8&8 im, then given another epi 0.3 sq.  After 3 1/2 hours of medications I was sent home.  I then had to return to the ER and receive 3 epi 0.4 sq, pertisone, and 75 mg of Benadryl.  I was also stridor at the point of arrival at the ER.  My question is that this was my first shot and being that I am going into a very high risk job, it has been strongly suggested to continue with this series if at all possible.  I am currently seeing an allergist and he would like to try and desentivize me.  Do you have any information on this being successful? Also is this a common reaction?  What would you suggest a course of action for me would be? Do you think that a second shot may have less of an effect on me?  Thanks for your time.
  Kerri

[HFHSM.D.-D.M.]

Dear Kerri:
I like to get difficult questions through MedHelp because they really get me thinking.  Your questions have done just that.  I’m going to try to give you some information and some options.  In the end, however, you are going to have to make some difficult decisions on your own balancing risks and benefits.
It sounds as if you had a substantial, anaphylactoid reaction to hepatitis B.  This is not common but we do see it on occasion.  Here are some of the things you can consider.  You can receive the desensitization.  I do not know how effective this will be but it can be very effective for other medications including antibiotics.  Your allergist should be able to give you more information about this.  If you go this route, I recommend the next injection be given in a highly monitored setting with epinephrine and other medications available.  Secondly, if you do resume the vaccination, you may consider switching to another hepatitis B vaccine.  I don’t know exactly, how the different vaccines are made, but it would be easy for you or your physicians to contact the manufacturers (Merck or SmithKline) to see if they can give you information about cross-allergic reactions.  I know that it does not change the effectiveness of the vaccine to switch between the brands.  
Another possibility is to just measure your antibody (anti-HBs) titers.  Some patients have an excellent response to one injection.  You may be such a patient.  If you have high titers you should be protected though you will have to check your titers periodically to make sure they stay in the protective range.  Finally, you could decide the risk of getting hepatitis B is less of a threat to your health than continuing with the vaccines.
It sounds as if you should sit down with your physicians and make a decision about the best course in this very complicated situation.  I hope this information is helpful to you. I would be interested in any additional information or questions you have. You can contact us through MEDHELP or at Henry Ford at [phone].
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.