II. Indication

  1. Many antitoxins and antivenins are from horse serum (e.g. original Diphtheria antitoxin)
  2. Skin Test for Horse Serum Sensitivity prior to use
    1. Rarely performed now

III. Efficacy: General

  1. No study (including Skin Test for Horse Serum Sensitivity) predicts Serum Sickness reaction
    1. Tantawichien (1995) Clin Infect Dis 21(3): 660 +PMID: 8527562 [PubMed]

IV. Efficacy: Controversial in Snake Antivenin (antivenom) use

  1. Previously indicated with older ACP antivenoms in which reactions were much more common
    1. Newer antivenoms (e.g. CroFab) have lower Incidence of reaction, and Skin Testing is not typically done
  2. Advantages to performing skin test prior to antivenin
    1. Possible medicolegal protection only
  3. Disadvantages to skin test prior to antitoxin
    1. Delays treatment (antitoxin administration)
    2. High false-positive rate: 33%
    3. High false-negative rate: 10 to 36%
    4. Has resulted in Anaphylaxis in some patients
  4. References
    1. Jurkovich (1998) J Trauma 28:1032-7 [PubMed]

V. Technique

  1. 0.1 ml of 1:10 dilution of antitoxin intradermal
  2. Inject at Forearm with 27 gauge

VI. Evaluation: Observe for Allergic Reaction for 20 minutes

  1. Local reaction
    1. Hyperemic areola at injection site > 0.5 cm
  2. Systemic reaction
    1. Fever, chills
    2. Hypotension with decrease Blood Pressure >20 mmHg
    3. Skin rash
    4. Respiratory difficulty
    5. Nausea, Vomiting
    6. Generalized itching

VII. Interpretation: If any signs of reaction

  1. Suggests Horse Serum Sensitivity
  2. Do not use antitoxin

VIII. Management: Consider Alternatives to Skin Testing

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