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Antivenom with previous reaction — DTM&H MCQ

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ModerateEnvironmental HealthAntivenom with previous reactionDTM&H

A clinical officer in a rural hospital in Malawi has a patient with a confirmed Russell's viper bite. Antivenom is available but the patient has a previous history of equine antivenom reaction. What is the most appropriate approach?

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Correct answer: D — Administer antivenom with low-dose adrenaline premedication

A previous reaction to equine antivenom increases the risk of an acute antivenom reaction, but it is not a reason to withhold indicated antivenom in significant viper envenoming. Antivenom should be given with close monitoring, resuscitation facilities immediately available, and low-dose adrenaline premedication to reduce or blunt early anaphylactic reactions. Desensitisation is inappropriate because it delays urgent treatment and is not recommended; antihistamine alone does not prevent severe anaphylaxis. Therefore, the best approach is to administer antivenom with low-dose adrenaline premedication.

Reference: World Health Organization Regional Office for Africa. Guidelines for the Prevention and Clinical Management of Snakebite in Africa. 2010. https://www.who.int/publications-detail-redirect/9789290231684