Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom
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 t...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Journal of Tropical Medicine |
| Online Access: | http://dx.doi.org/10.1155/2019/2689171 |
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| author | Sanjib Kumar Sharma Emilie Alirol Anup Ghimire Suman Shrestha Rupesh Jha Surya B. Parajuli Deekshya Shrestha Surya Jyoti Shrestha Amir Bista David Warrell Ulrich Kuch Francois Chappuis Walter Robert John Taylor |
| author_facet | Sanjib Kumar Sharma Emilie Alirol Anup Ghimire Suman Shrestha Rupesh Jha Surya B. Parajuli Deekshya Shrestha Surya Jyoti Shrestha Amir Bista David Warrell Ulrich Kuch Francois Chappuis Walter Robert John Taylor |
| author_sort | Sanjib Kumar Sharma |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-d95432c5c0ab4115a423a60d6d6e9d7e |
| institution | Kabale University |
| issn | 1687-9686 1687-9694 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
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| series | Journal of Tropical Medicine |
| spelling | doaj-art-d95432c5c0ab4115a423a60d6d6e9d7e2025-02-03T00:59:58ZengWileyJournal of Tropical Medicine1687-96861687-96942019-01-01201910.1155/2019/26891712689171Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent AntivenomSanjib Kumar Sharma0Emilie Alirol1Anup Ghimire2Suman Shrestha3Rupesh Jha4Surya B. Parajuli5Deekshya Shrestha6Surya Jyoti Shrestha7Amir Bista8David Warrell9Ulrich Kuch10Francois Chappuis11Walter Robert John Taylor12B.P. Koirala Institute of Health Sciences, Dharan, NepalDivision of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, SwitzerlandB.P. Koirala Institute of Health Sciences, Dharan, NepalSnake Bite Treatment Centre Nepal Red Cross Society, Chapter Damak, Jhapa, NepalBharatpur Hospital, Bharatpur, Chitwan 44200, NepalSnake Bite Management Centre Charali, Charali, Jhapa, NepalBharatpur Hospital, Bharatpur, Chitwan 44200, NepalBharatpur Hospital, Bharatpur, Chitwan 44200, NepalSnake Bite Treatment Centre Nepal Red Cross Society, Chapter Damak, Jhapa, NepalNuffield Department of Clinical Medicine, University of Oxford, Oxford, UKInstitute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, GermanyDivision of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, SwitzerlandDivision of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, SwitzerlandDiagnosing 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.http://dx.doi.org/10.1155/2019/2689171 |
| spellingShingle | Sanjib Kumar Sharma Emilie Alirol Anup Ghimire Suman Shrestha Rupesh Jha Surya B. Parajuli Deekshya Shrestha Surya Jyoti Shrestha Amir Bista David Warrell Ulrich Kuch Francois Chappuis Walter Robert John Taylor Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom Journal of Tropical Medicine |
| title | Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom |
| title_full | Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom |
| title_fullStr | Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom |
| title_full_unstemmed | Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom |
| title_short | Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom |
| title_sort | acute severe anaphylaxis in nepali patients with neurotoxic snakebite envenoming treated with the vins polyvalent antivenom |
| url | http://dx.doi.org/10.1155/2019/2689171 |
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