Despite the high degree of purification of the serum, it is recommended to perform a skin test before administering Anti-Rabies Serum (Equine). As per department of disease control, Thailand, the skin test consists of an intradermal injection 1:100 dilution of Anti-Rabies Serum (Equine) (0.02 mL) on the volar surface of the forearm. An equivalent of intradermal injection of physiological saline solution is used as control. The observations made 15-20 minutes after intradermal injection is considered to be positive, if >10 mm diameter of wheal appears with flare surrounded and the control is negative or if the control shows dermal reaction and sample shows a bigger reaction than the control. As per WHO, there are no scientific grounds for performing a skin test prior to administering Equine Rabies Immunoglobulin (ERIG) because testing does not predict reactions, and it should still be given whatever the result of the test. A positive test result is not a formal contraindication for the use of Equirab therapy , but it should be considered as warning. In such case, Equirab should be administered only after ensuring the facility is equipped to overcome anaphylactic shock. It should be kept in mind that a negative skin test does not guarantee that anaphylaxis would not occur.
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