[A case received pre-exposure immunization against rabies by intradermal injection of rabies vaccine because of allergic reaction to the component of the vaccine].

A female, 25 years of age, came to our clinic to receive pre-exposure immunization against rabies. In another hospital she was tested to find out whether she was allergic to the components of rabies vaccine (PCEC) manufactured by the Chemo-Sero-Theraptic Research Institute (Kaketsuken) by cutaneous reaction using a 2,000-fold diluted PCEC. She showed a positive reaction. In our clinic she was again examined by skin test using 0.1 ml of 10-fold diluted PCEC. She showed wheal and flare reaction. Further we tested using 0.05 ml and 0.1 ml of non-diluted PCEC. Her skin reaction did not increase by several mm in diameter. So we decided to immunized her against rabies with intradermal injections of PCEC instead of subcutaneous injections that is indicated by the manufacturer. The second intradermal injections were done to right and left forearms a week later. Then the third shot was given 4 weeks after the second. At 2 weeks after the third injection her blood sample was taken to measure anti-rabies antibody titer by ELISA method with Platelia rabies kit (Diagnostic Pasteur, France). She had 6.7 U/ml of anti-rabies ELISA antibody that was much higher than the protective level (0.5 IU/ml) officially recognized by WHO. Therefore, it is concluded that she had produced sufficiently high level of anti-rabies antibody with intradermal injection of PCEC. It is reasonably recommended to investigate further if the intradermal injection of PCEC will be an effective method as a pre-exposure immunization against rabies.