Oral Presentation: 30 minutes 11th Asia-Pacific Congress of the International Society on Toxinology 2021

Redback spider antivenom effectiveness in South Australian children (#15)

Jane Cocks 1 , Simon Chu 2 , Lalith Gamage 1 , Sasha Rossaye 1 , Jacquie Schutz 1 , Aun Woon Soon 3
  1. Paediatric Emergency, The Women's and Children's Hospital, Adelaide, SA, Australia
  2. Emergency Department, The Lyell McEwin Hospital, Adelaide, SA, Australia
  3. Emergency Department, Flinders Medical Centre, Adelaide, SA, Australia

The redback spider (Latrodectus hasselti) is the commonest cause of clinically significant spider bite in Australia  (1) (2). Latrodectism, the clinical syndrome of envenomation, occurs in approximately one third of bites, characterised by local, regional and /or generalised pain, increasing over time, associated with diaphoresis, hypertension, nausea, vomiting, headache, malaise and fatigue (3) (4). Redback antivenom (RBAV) has been used in Australia since 1956 with clinical effectiveness of 92-100% documented in retrospective studies (5) (6) (7) . The prospective RAVE studies published in 2008 and 2014 significantly questioned the effectiveness of RBAV in predominately adult patients, with the result that some states in Australia now no longer recommend or provide RBAV as a treatment option for envenomation (2) (8).

This study describes the South Australian paediatric redback spider bite experience over a 10-year time period and examines the hypothesis that Redback Antivenom (RBAV) treatment in children is clinically effective. A retrospective Emergency Department chart review was performed of children with a discharge diagnosis of redback spider envenomation between 1st January 2010 and 31st March 2020. There were 256 patient encounters involving 235 patients. Latrodectism was described in one third of the cases (34%). Sixty-one patients received RBAV and in 57 patients (93%) the RBAV had good clinical effect. Two hours post RBAV administration, pain resolved in 71%, hypertension resolved in 62%, diaphoresis resolved in 43% and tachycardia resolved in 82%. There were no cases of urticaria or anaphylaxis and one case of serum sickness.

This retrospective review has demonstrated clinical effectiveness of RBAV in paediatric patients across all age groups, observed in both clinician perceived results and measurable outcomes. Redback antivenom remains an effective treatment for redback envenomation in children.

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