Pre-procedure acute phase protein response to tetanus toxoid vaccination: Potential role for reduction of post-ERCP pancreatitis - A final analysis

E. Fogel, K. Gottlieb, J. Flueckiger, S. Sherman, G. Lehman

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Background: Alpha-1-antitrypsin (α-1-AT) is responsible for ∼90% of the anti-protease activity in serum. High endogenous levels of α-1-AT have been reported to confer a degree of protection against post-ERCP pancreatitis. It has been demonstrated that α-1-AT levels rise after diphtheria-tetanus-poliotyphoid vaccination (Clin Sci 1995;89:389). This study examined the effect of Tetanus toxoid vaccination alone [Td] (Connaught Labs) on pre-ERCP α-1-AT levels. Methods: Patients seen 24, 48 or 72h prior to their ERCP were recruited. Exclusion criteria included active infection, immunosuppression or Td within 1 year of study entry. Baseline α-1-AT and C-reactive protein [CRP] (control) levels were drawn prior to intramuscular Td and again at 24h intervals including immediately prior to ERCP; 8 patients returned for blood tests at two or more intervals. Results: From 9/96 - 8/97, 30 pts were vaccinated. Two of the 20 pts at 24h had 40% and 60% elevations in CRP levels without corresponding increases in α-1-AT. One of 13 pts who received Td 48h prior to ERCP had 145% and 9% elevations in CRP and α-1-AT, respectively; 3 others had 34%, 25% and 120% elevations in CRP levels but no change in α-1-AT. One pt at 72h had 58% and 9% elevations in CRP and α-1-AT, respectively, while 3 others had isolated increases in CRP or α-1-AT alone without corresponding increases in the other acute phase protein. Significant adverse effects from Td were not reported by any patient. ACUTE PHASE PROTEIN LEVELS AFTER TETANUS TOXOID Mean serum α-1-AT*mean serum CRP*Pre post pre post 24h (n = 20) 172 ± 25 165 ± 22**0.7 ± 0.3 0.7 ± 0.2**48h (n=13) 172 ± 44 162 ± 47**0.9 ± 0.8 1.2 ± 1.2**72h (n = 10) 172 ± 26 173 ± 24**0.7 ± 0.4 0.9 ± 0.6**± 1 standard deviation;*mg/dl;**pre vs post: p > .05 Summary: Pre-procedure vaccination with Tetanus toxoid is not an adequate stimulus to cause a significant elevation of acute phase proteins. Conclusion: Further study is needed to determine the optimal stimulus and timing of intervention necessary to elevate endogenous α-1-AT levels, and hopefully decrease the incidence of post-ERCP pancreatitis.

Original languageEnglish (US)
Pages (from-to)AB136
JournalGastrointestinal endoscopy
Issue number4
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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