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Despite WHO does not recommend to perform the skin test before administration of Equine Rabies Immunoglobulin (WHO Expert Consultation on Rabies, WHO TRS 982), the skin test can still be applied and performed according to the Clinical Practice Guidelines 2012 for Rabies Disease of the Ministry of Public Health. The skin test should be performed as follows: Prepare 1:100 dilution of Vinrab with normal saline solution.
Provide the intradermal injection of 0.02 mL of diluted solution to the inside part of the forearm so as to obtain the wheal (3 mm diameter).
An equivalent intradermal injection of normal saline solution at another side of the forearm is used as control.
The observations made 15-20 minutes after the intradermal injection is considered to be positive if: >10 mm diameter of wheal appears with flare surrounded and the control is negative.
The control shows dermal reaction and the sample shows a bigger reaction than the control.
A positive test result is not a formal contra-indication for the use of serotherapy, but it should be considered as a warning. In such cases, Human Rabies Immunoglobulin (HRIG) should be used instead of. If HRIG is not available, VINRAB shall be used with caution and under the physicians' observation. Adequate treatment including adrenaline (epinephrine), antihistamine and respirator should be prepared and provided for immediate use. A negative test is not an absolute guarantee for the absence of an immediate allergic type reaction.
Adequate treatment for anaphylaxis reaction should also be prepared even the result is negative.
