TY  - JOUR
A1  - Sharma, Sanjib Kumar
A1  - Alirol, Emilie
A1  - Ghimire, Anup
A1  - Shrestha, Suman
A1  - Jha, Rupesh
A1  - Parajuli, Surya B.
A1  - Shrestha, Deekshya
A1  - Shrestha, Surya Jyoti
A1  - Bista, Amir
A1  - Warrell, David A.
A1  - Kuch, Ulrich
A1  - Chappuis, François
A1  - Taylor, Walter Robert John
T1  - Acute severe anaphylaxis in Nepali patients with neurotoxic snakebite envenoming treated with the vins polyvalent antivenom
T2  - Journal of tropical medicine
N2  - Diagnosing and treating acute severe and recurrent antivenom-related anaphylaxis (ARA) is challenging and reported experience is limited. Herein, we describe our experience of severe ARA in patients with neurotoxic snakebite envenoming in Nepal. Patients were enrolled in a randomised, double-blind trial of high vs. low dose antivenom, given by intravenous (IV) push, followed by infusion. Training in ARA management emphasised stopping antivenom and giving intramuscular (IM) adrenaline, IV hydrocortisone, and IV chlorphenamine at the first sign/s of ARA. Later, IV adrenaline infusion (IVAI) was introduced for patients with antecedent ARA requiring additional antivenom infusions. Preantivenom subcutaneous adrenaline (SCAd) was introduced in the second study year (2012). Of 155 envenomed patients who received ≥ 1 antivenom dose, 13 (8.4%), three children (aged 5−11 years) and 10 adults (18−52 years), developed clinical features consistent with severe ARA, including six with overlapping signs of severe envenoming. Four and nine patients received low and high dose antivenom, respectively, and six had received SCAd. Principal signs of severe ARA were dyspnoea alone (n=5 patients), dyspnoea with wheezing (n=3), hypotension (n=3), shock (n=3), restlessness (n=3), respiratory/cardiorespiratory arrest (n=7), and early (n=1) and late laryngeal oedema (n=1); rash was associated with severe ARA in 10 patients. Four patients were given IVAI. Of the 8 (5.1%) deaths, three occurred in transit to hospital. Severe ARA was common and recurrent and had overlapping signs with severe neurotoxic envenoming. Optimising the management of ARA at different healthy system levels needs more research. This trial is registered with NCT01284855.
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50914
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-509142
SN  - 1687-9694
SN  - 1687-9686
N1  - Copyright © 2019 Sanjib Kumar Sharma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
VL  - 2019
IS  - Art. 2689171
SP  - 1
EP  - 12
PB  - Hindawi
CY  - New York, NY
ER  -