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Interventions for preventing reactions to snake antivenom
1Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok, Thailand, 10330. fmedinp@md2.md.chula.ac.th
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Routine adrenaline may reduce adverse reactions to snake antivenom, particularly for polyspecific antivenoms with high adverse event rates. Antihistamines showed no benefit in preventing acute reactions from antivenoms.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Medicine
Background:
- Snake antivenom neutralizes venom toxins but can cause severe adverse effects like anaphylaxis.
- Adverse reactions are a significant concern in antivenom therapy.
Purpose of the Study:
- To evaluate the efficacy of prophylactic drugs administered with snake antivenom to mitigate adverse events.
- Assessing the role of adrenaline, antihistamines, and corticosteroids in preventing antivenom reactions.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searched the Cochrane Controlled Trials Register and contacted researchers for relevant studies.
- Data extraction and quality assessment performed by two independent reviewers.
Main Results:
- One trial (n=105) in Sri Lanka indicated that adrenaline reduced adverse reactions when given with polyspecific antivenom.
- This protective effect of adrenaline was consistent across different severity strata.
- A separate trial (n=101) in Brazil found no benefit from antihistamine drugs when used with various Bothrops antivenoms.
Conclusions:
- Routine prophylactic use of adrenaline appears reasonable for polyvalent antivenoms with known high rates of adverse events, based on limited evidence.
- Clinicians should consider randomized trials if local factors suggest adrenaline is not warranted.
- Antihistamines do not appear to offer significant benefits in preventing acute antivenom reactions.