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Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis.
Med J Aust 2008; 188(8):473-6MJ

Abstract

OBJECTIVE

To investigate current use of Australian snake antivenoms and the frequency and severity of immediate-type hypersensitivity reactions.

DESIGN

Nested prospective cohort study as part of the Australian Snakebite Project.

PATIENTS AND SETTING

Patients receiving snake antivenom in Australian hospitals between 1 January 2002 and 30 November 2007.

MAIN OUTCOME MEASURES

The use of CSL Limited antivenom; frequency and severity of hypersensitivity reactions to antivenom; premedication and treatment of these reactions.

RESULTS

Snake antivenom was administered to 195 patients, mostly for venom-induced consumption coagulopathy (145 patients, 74%), followed by non-specific systemic effects (12%), neurotoxicity (5%) and myotoxicity (4%). Antivenom was given to nine patients (5%) without evidence of envenoming or who were bitten by a species of snake for which antivenom is not required. The commonest antivenoms used were brown snake (46%), tiger snake (30%) and polyvalent (11%). The median dose was four vials (interquartile range, 2-5 vials), and 24 patients received two different types of antivenom. Immediate-type hypersensitivity reactions occurred in 48 patients (25%); 21 satisfied our definition of anaphylaxis, with 11 moderate and 10 severe cases, including nine in which patients were hypotensive. The remaining 27 reactions were mild (skin only). Adrenaline was used in 26 cases with good effect. The frequency of reactions to tiger snake (41%) and polyvalent (41%) antivenoms was higher than that to brown snake antivenom (10%). Hypersensitivity reactions occurred in 11 of 40 patients receiving any form of premedication (28%) and in 2 of 11 given adrenaline for premedication (18%) versus 20 of 86 not receiving premedication (23%).

CONCLUSIONS

Antivenom was used appropriately, and most commonly for coagulopathy. Hypersensitivity reactions were common, but most were not severe. The discretionary use of premedication was not associated with any reduction in reactions.

Authors+Show Affiliations

Menzies School of Health Research, Charles Darwin University, Darwin, NT.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18429716

Citation

Isbister, Geoffrey K., et al. "Current Use of Australian Snake Antivenoms and Frequency of Immediate-type Hypersensitivity Reactions and Anaphylaxis." The Medical Journal of Australia, vol. 188, no. 8, 2008, pp. 473-6.
Isbister GK, Brown SG, MacDonald E, et al. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J Aust. 2008;188(8):473-6.
Isbister, G. K., Brown, S. G., MacDonald, E., White, J., & Currie, B. J. (2008). Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. The Medical Journal of Australia, 188(8), pp. 473-6.
Isbister GK, et al. Current Use of Australian Snake Antivenoms and Frequency of Immediate-type Hypersensitivity Reactions and Anaphylaxis. Med J Aust. 2008 Apr 21;188(8):473-6. PubMed PMID: 18429716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. AU - Isbister,Geoffrey K, AU - Brown,Simon G, AU - MacDonald,Ellen, AU - White,Julian, AU - Currie,Bart J, AU - ,, PY - 2007/09/19/received PY - 2007/11/29/accepted PY - 2008/4/24/pubmed PY - 2008/7/17/medline PY - 2008/4/24/entrez SP - 473 EP - 6 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 188 IS - 8 N2 - OBJECTIVE: To investigate current use of Australian snake antivenoms and the frequency and severity of immediate-type hypersensitivity reactions. DESIGN: Nested prospective cohort study as part of the Australian Snakebite Project. PATIENTS AND SETTING: Patients receiving snake antivenom in Australian hospitals between 1 January 2002 and 30 November 2007. MAIN OUTCOME MEASURES: The use of CSL Limited antivenom; frequency and severity of hypersensitivity reactions to antivenom; premedication and treatment of these reactions. RESULTS: Snake antivenom was administered to 195 patients, mostly for venom-induced consumption coagulopathy (145 patients, 74%), followed by non-specific systemic effects (12%), neurotoxicity (5%) and myotoxicity (4%). Antivenom was given to nine patients (5%) without evidence of envenoming or who were bitten by a species of snake for which antivenom is not required. The commonest antivenoms used were brown snake (46%), tiger snake (30%) and polyvalent (11%). The median dose was four vials (interquartile range, 2-5 vials), and 24 patients received two different types of antivenom. Immediate-type hypersensitivity reactions occurred in 48 patients (25%); 21 satisfied our definition of anaphylaxis, with 11 moderate and 10 severe cases, including nine in which patients were hypotensive. The remaining 27 reactions were mild (skin only). Adrenaline was used in 26 cases with good effect. The frequency of reactions to tiger snake (41%) and polyvalent (41%) antivenoms was higher than that to brown snake antivenom (10%). Hypersensitivity reactions occurred in 11 of 40 patients receiving any form of premedication (28%) and in 2 of 11 given adrenaline for premedication (18%) versus 20 of 86 not receiving premedication (23%). CONCLUSIONS: Antivenom was used appropriately, and most commonly for coagulopathy. Hypersensitivity reactions were common, but most were not severe. The discretionary use of premedication was not associated with any reduction in reactions. SN - 0025-729X UR - https://www.unboundmedicine.com/medline/citation/18429716/Current_use_of_Australian_snake_antivenoms_and_frequency_of_immediate_type_hypersensitivity_reactions_and_anaphylaxis_ L2 - https://www.mja.com.au/public/issues/188_08_210408/isb11096_fm.html DB - PRIME DP - Unbound Medicine ER -