Comparative study of anaphylaxis incidence in patients receiving anti-snake venom with or without prophylactic adrenaline: a prospective, randomized, blinded study
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20162449Keywords:
Snake bites, Antivenins, Anaphylaxis, AdrenalineAbstract
Background: Anti-snake venom serum (ASV) administered for snake-bite patients is the most specific treatment available. Unfortunately, it can cause severe anaphylaxis which can be fatal sometimes.
Methods: Fifty patients were included in the study and randomly divided into group A, who received sub-cutaneous adrenaline before administration of anti-venom serum and group B who did not. Each group comprised of twenty-five patients. The incidences as well as the severity of anaphylaxis in both groups and also the effects of subcutaneous adrenaline on the hemodynamic were analysed.
Results: Anaphylactic reactions were significantly less in group A than group B population (p<0.05). Hemodynamic variables such as blood pressure, pulse rate have responded similarly in both the groups (p>0.05) implying that administration of sub-cutaneous adrenaline is safe.
Conclusions: Prophylactic subcutaneous adrenaline before anti snake venom administration is highly efficacious and safe in reducing the incidence as well as severity of anaphylactic reactions.
References
Nuchprayoon I, Garner P. Interventions for preventing reactions to snake anti-venom. Cochrane Database of systematic Reviews. 1999;4:CD 002153.
Malasit P, Warrel DA, Chanthavanich P, Viravan C, Mongkolsapaya J, Singhthong B, et al. Prediction, prevention, and mechanism of early (anaphylactic) antivenom reaction in victims of snake bites. BMJ. 1986;292:17-20.
Sutherland SK. Serum reactions-an analysis of commercial anti-venoms and the possible role of anti-complementery activity in de-novo reactions to anti-venoms and antitoxins. Medical Journal of Australia. 1977;1:613-5.
Mahadevan S. Drug alert, RPC (South) JIPMER, Pondicherry, INDIA. 2005;1(2):1-8.
Premawardhena AP, de Silva CE, Fonseka MM, Gunatilake SB, de Silva HJ. Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial. BMJ. 1999;318:1041-1043.
Indian National Snakebite Protocols 2009. Available at http://164.100.130.11:8091/nationalsnakebitemanagementprotocol.pdf.
UPCC. Anti-venom therapy for snake bite. UPCC. 2001;(3)1:1-4. Available at https://poisoncontrol.utah.edu/newsletters/pdfs/toxicology-today-archive/Vol3_No1.pdf.
Williams DJ, Jensen SD, Nimorakiotakis B, Muller R, Winkel KD. Antivenom use, premedication and early adverse reactions in the management of snakebites in rural Papua New Guinea. Toxicon. 2007;49:780-92.
De silva HA, Pathmeshwaran A, Ranasinha CD, Jayamanne S, Samarakoon SB, Hittharage A, et al. Low dose adrenaline, promethazine and hydrocortisone in the prevention of acute adverse reactions to anti-venom following snake bite: a randomized, double blinded, placebo controlled trial. PLOS Med. 2011;8(5):e1000435.
Amin MR, Mamun SMH, Rashid R, Rahman M, Ghose A, Sharmin S, et al. Anti-snake venom: use and adverse reaction in a snake bite study clinic in Bangladesh. J Venom Anim Toxins incl Trop Dis. 2008;14(4):660-72.
Fan HW, Marcopito LF, Cardoso JL. Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snakebites. BMJ. 1999;318:1451-2.
Dassanayake AS, Karunanayake P, Kasturiratne KT. Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite. Ceylon Med J. 2000;47:48-9.
