Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22).
BACKGROUND
Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sickness but the incidence and characteristics are poorly defined.


OBJECTIVE
To investigate the incidence and clinical features of serum sickness following the administration of Australian snake antivenoms.


METHODS
This was a prospective cohort study of patients recruited to the Australian Snakebite Project who received snake antivenom from November 2012 to March 2014. Demographics, clinical information, laboratory tests and antivenom treatment were recorded prospectively. Patients administered antivenom were followed up at 7-10 days and 6 weeks' post-antivenom. The primary outcome was the proportion with serum sickness, pre-defined as three or more of: fever, erythematous rash/urticaria, myalgia/arthralgia, headache, malaise, nausea/vomiting 5-20 days post-antivenom.


RESULTS
During the 16-month period, 138 patients received antivenom. 23 were not followed up (unable to contact, tourist, child, bee sting) and 6 died in hospital. Of 109 patients followed up, the commonest reason for antivenom was venom induced consumption coagulopathy in 77 patients. An acute systemic hypersensitivity reaction occurred post-antivenom in 25 (23%) and 8 (7%) were severe with hypotension. Serum sickness occurred in 32/109 (29%) patients, including 15/37 (41%) given tiger snake, 6/15 (40%) given polyvalent and 4/23 (17%) given brown snake antivenom. There was no association between the volume of antivenom and serum sickness, p = 0.18. The commonest effects were lethargy, headache, muscle/joint aches and fever.


CONCLUSIONS
The incidence of serum sickness after snake antivenom in Australia was higher than earlier investigations which failed to define symptoms or follow-up patients, but similar to more recent studies of antivenoms in the United States.


CONCLUSIONS
Serum sickness is common with Australian snake antivenom but does not appear to be predictable based on the volume of antivenom administered.
a Clinical Toxicology Research Group, University of Newcastle , Newcastle , NSW , Australia.
Nicole M
NM
Ryan
a Clinical Toxicology Research Group, University of Newcastle , Newcastle , NSW , Australia.|b Department of Clinical Toxicology and Pharmacology , Calvary Mater Newcastle , Newcastle , NSW , Australia.
Renai T
RT
Kearney
c Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital and the University of Western Australia , Perth , Australia.
Simon G A
SG
Brown
a Clinical Toxicology Research Group, University of Newcastle , Newcastle , NSW , Australia.|b Department of Clinical Toxicology and Pharmacology , Calvary Mater Newcastle , Newcastle , NSW , Australia.
Geoffrey K
GK
Isbister
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012713:Serum Sickness / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D012909:Snake Bites / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012910:Snake Venoms; D013997:Time Factors; D055815:Young Adult
D000997:Antivenins; D012910:Snake Venoms
Delayed immune reaction; serum hypersensitivity; snake envenomation