High incidence of early anaphylactoid reaction to SAIMR polyvalent snake antivenom

Moran, Neil F.; Newman, William J.; Theakston, R.David G.; Warrell, David A.; Wilkinson, David

« Previous Next »Transactions of the Royal Society of Tropical Medicine and Hygiene
Volume 92, Issue 1 , Pages 69-70, January 1998

High incidence of early anaphylactoid reaction to SAIMR polyvalent snake antivenom

Neil F. Moran
- Author for correspondence. The authors are members of the Zululand Snakebite Research Group.
- Hlabisa Hospital, Private Bag X5001, Hlabisa 3937, South Africa
- Centre for Tropical Medicine and Infectious Diseases, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
William J. Newman
- Hlabisa Hospital, Private Bag X5001, Hlabisa 3937, South Africa
- Centre for Tropical Medicine and Infectious Diseases, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
R.David G. Theakston
- Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Tropical Medicine and Infectious Diseases, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
David A. Warrell
- Centre for Epidemiological Research in Southern Africa, South African Medical Research Council, South Africa
- Centre for Tropical Medicine and Infectious Diseases, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
David Wilkinson
- Hlabisa Hospital, Private Bag X5001, Hlabisa 3937, South Africa
- Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Epidemiological Research in Southern Africa, South African Medical Research Council, South Africa
- Centre for Tropical Medicine and Infectious Diseases, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

Received 24 April 1997; received in revised form 18 August 1997; accepted 18 August 1997.

Abstract

During a prospective study of 147 patients with snakebite presenting to a rural South African hospital, 13 of 17 patients (76%) treated with South African Institute for Medical Research (SAIMR) polyvalent antivenom experienced potentially severe early (anaphylactoid) reactions. The most common reaction was generalized urticaria (12; 71%), but 3 cases of angio-oedema (18%), 2 of bronchospasm (12%), and 2 of hypotension (12%) were also observed. Reactions were controlled with adrenaline, antihistamines, and resuscitation. All patients fully recovered from envenoming although the full dose of antivenom was not given to most. Indications for the use of this antivenom should be reconsidered and patients should be given antivenom in a high care setting if possible. Use of antivenom by lay people outside hospital should be discouraged and antivenom manufacturing processes could usefully be reviewed.

Keywords: snakebite, antivenom, anaphylactoid reaction, South Africa

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