Before using, the ampoule package must be examined with care. Any broken ampoules containing precipitates or particles must be discarded.
Before injecting the antiserum, information should be obtained whenever possible as to whether previous injections of antiserum have been received and whether the patient is subject to hypersensitivity disorders.
Sensitivity testing should be performed before the administration of antisera. The patient must be kept under observation after the administration of doses of antisera. Adrenaline injection and resuscitation facilities should be available.
Sensitivity test should be done. Dilute the Antitoxin 1:10 with physiological saline (i.e. 0.1 mL antitoxin + 0.9 mL saline) and inject 0.05 mL of the diluted antitoxin intracutaneously on the flexor surface of the forearm. A positive reaction characterized by erythema, edema or infiltration appearing in 15-30 minutes denotes sensitivity to horse serum preparation. A negative reaction may be treated in the usual manner, a positive reaction must be desensitized when antitoxin administration is available.
The following desensitization procedure may be recommended: dilute the antitoxin 1:10 with sterile physiological saline. Inject subcutaneously 0.2 mL at first, observe for 30 minutes. If no reaction occurs, give another injection with higher dose. If no reaction occurs, give the third injection and so forth. If there still no reaction, then the administration of undiluted antitoxin can be started.
Adrenaline should always be at hand. In case of anaphylaxis, adrenaline should be given at once. All patients who developed hypersensitive reactions following injection should be handled properly.