Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine)

Ann Emerg Med. 2002 Jun;39(6):677-9. doi: 10.1067/mem.2002.124442.

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.]

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / therapeutic use
  • Antivenins / administration & dosage
  • Antivenins / adverse effects*
  • Famotidine / therapeutic use
  • Histamine H1 Antagonists / therapeutic use
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Hydroxyzine / therapeutic use
  • Hypersensitivity, Immediate / drug therapy
  • Hypersensitivity, Immediate / etiology
  • Hypersensitivity, Immediate / physiopathology*
  • Immunoglobulin Fab Fragments
  • Immunoglobulin Fragments / administration & dosage
  • Immunoglobulin Fragments / adverse effects*
  • Male
  • Methylprednisolone / therapeutic use
  • Snake Bites / drug therapy*

Substances

  • Anti-Inflammatory Agents
  • Antivenins
  • Crotalidae Polyvalent immune Fab
  • Histamine H1 Antagonists
  • Histamine H2 Antagonists
  • Immunoglobulin Fab Fragments
  • Immunoglobulin Fragments
  • Hydroxyzine
  • Famotidine
  • Methylprednisolone