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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ftdoajarticles:oai:doaj.org/article:d95432c5c0ab4115a423a60d6d6e9d7e 2024-09-09T19:27:17+00:00 Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom 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 2019-01-01T00:00:00Z https://doi.org/10.1155/2019/2689171 https://doaj.org/article/d95432c5c0ab4115a423a60d6d6e9d7e EN eng Wiley http://dx.doi.org/10.1155/2019/2689171 https://doaj.org/toc/1687-9686 https://doaj.org/toc/1687-9694 1687-9686 1687-9694 doi:10.1155/2019/2689171 https://doaj.org/article/d95432c5c0ab4115a423a60d6d6e9d7e Journal of Tropical Medicine, Vol 2019 (2019) Arctic medicine. Tropical medicine RC955-962 article 2019 ftdoajarticles https://doi.org/10.1155/2019/2689171 2024-08-05T17:48:41Z 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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Journal of Tropical Medicine 2019 1 12 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 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 |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 |
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 in Journal/Newspaper |
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 |
title |
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_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_sort |
acute severe anaphylaxis in nepali patients with neurotoxic snakebite envenoming treated with the vins polyvalent antivenom |
publisher |
Wiley |
publishDate |
2019 |
url |
https://doi.org/10.1155/2019/2689171 https://doaj.org/article/d95432c5c0ab4115a423a60d6d6e9d7e |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Journal of Tropical Medicine, Vol 2019 (2019) |
op_relation |
http://dx.doi.org/10.1155/2019/2689171 https://doaj.org/toc/1687-9686 https://doaj.org/toc/1687-9694 1687-9686 1687-9694 doi:10.1155/2019/2689171 https://doaj.org/article/d95432c5c0ab4115a423a60d6d6e9d7e |
op_doi |
https://doi.org/10.1155/2019/2689171 |
container_title |
Journal of Tropical Medicine |
container_volume |
2019 |
container_start_page |
1 |
op_container_end_page |
12 |
_version_ |
1809896741270454272 |