A retrospective study of antivenom-associated adverse reaction and anaphylaxis at Ngwelezana Hospital, South Africa

Background: Snakebite victims are commonly seen in KwaZulu-Natal Hospitals, with only a minority of patients requiring antivenom. This study reviewed antivenom-associated adverse events at our institution, after admin-istration of the South African Vaccine Producers (SAVP) polyvalent antivenom.Methods: A retrospective review, over 52 months (January 2016-April 2020), of patients who received anti -venom. Demographics, clinical details and clinical course following antivenom administration were analysed.Results: Emergency department doctors treated 758 snakebites; 156 patients were admitted of which 51 (33%) received antivenom. Indications for antivenom included: neurotoxicity (24%), haemotoxicity (18%) and sig-nificant cytotoxicity (58%). Antivenom-associated adverse events occurred in 61% of patients; with 47% developing anaphylaxis requiring adrenaline infusion. There was a higher incidence of anaphylaxis in children (57%) than in adults (40%), p = 0.55. There was no association between antivenom dose and anaphylaxis. No benefit was noted with adrenaline premedication (p = 0.64), nor with the addition of antihistamine or steroid pre-medicants to adrenaline (p = 0.61). Multivariable logistic regression identified age as a predictor for anaphylaxis, but not dose or duration of antivenom and not any particular form of premedication. Intubation was required in 29% of patients developing anaphylaxis. There were no deaths and all patients made full recovery.Conclusion: Almost half of the patients at Ngwelezana hospital in Kwazulu-Natal receiving the SAVP polyvalent antivenom developed anaphylaxis requiring adrenaline infusion, with children at higher risk. The administration of this antivenom must only be given for valid indications, in a high-care environment by medical personnel ready to manage anaphylactic shock. The addition of antihistamine and corticosteroids to adrenaline for pre-medication has no added benefit.