title: Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine).
abstract: A 16-year-old boy presented to the emergency department with rapidly progressing extremity pain, edema, and ecchymosis after envenomation by a copperhead. Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) was infused. Six vials were placed in 250 mL of normal saline solution, and the infusion was gradually increased. Fifty minutes after beginning, the infusion was increased to 640 mL/h. Within minutes of the rate increase, the patient experienced full-body urticaria, facial edema, voice change, and tachycardia. The infusion was stopped. Hydroxyzine pamoate, famotidine, methylprednisolone, and a 1-L bolus of normal saline solution were administered intravenously. The symptoms abated, and the remaining FabAV was infused at a slower rate without return of this reaction. This immediate hypersensitivity reaction was most likely a rate-related anaphylactoid reaction that has not been previously reported with FabAV.[Holstege CP, Wu J, Baer AB. Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine). Ann Emerg Med. June 2002;39:677-679.]
authors.affiliation: Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0699, USA. ch2xf@virginia.edu
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Holstege
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wu
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Baer
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000997:Antivenins / Q000008:administration & dosage / Q000009:adverse effects*; D015738:Famotidine / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use; D006969:Hypersensitivity, Immediate / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D012909:Snake Bites / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments; D006919:Hydroxyzine; D015738:Famotidine; D008775:Methylprednisolone