Allergic Manifestations to Equine Rabies Immunoglobulin: A Case Series
Abstract
Introduction: Rabies is a vaccine preventable zoonotic disease, however, if not prevented in time, it may become 100% fatal. Combining vaccine- immunoglobulin therapy with proper wound care is advised for effective rabies prevention. Equine rabies immunoglobulin is cheaper than human rabies immunoglobulin, but there is an increased chance of hypersensitivity reaction following its administration.
Method: A case series study has been presented in this article consisting of three different presentations of hypersensitivity reactions after the administration of equine rabies immunoglobulin.
Results: Two cases developed an immediate allergic reaction after desensitization. The third case showed a delayed local reaction and did not develop any allergy during the skin test before administering the full dose.
Conclusion: In a poor resource setting like India, skin sensitivity testing may be continued to identify high risk patients, and provide desentization, but still allergic reactions may be anticipated for them.
References
World Health Organization [Internet]. Rabies; [cited 2023 Jan 27]. Available from: https://www.who.int/ news-room/fact-sheets/detail/rabies
Shantavasinkul P, Wilde H. Postexposure prophylaxis for rabies in resource-limited/poor countries. In: Jackson
AC, editor. Advances in virus research [Internet]. Vol. 79. Academic Press; 2011 [cited 2023 Jan 27]. p. 291-
Available from: https://www.sciencedirect.com/ science/article/pii/B9780123870407000135 [Google Scholar]
National Centre for Disease Control [Internet]. National guidelines for rabies prophylaxis, 2019. National Rabies Control Programme; 2019 [cited 2023 Jan 27]. Available from: https://ncdc.gov.in/WriteReadData/linkimages/ NationalGuidelinesforRabiesprophylaxis2019.pdf
Tantawichien T, Benjavongkulchai M, Wilde H, Jaijaroensup W, Siakasem A, Chareonwai S, Youhtong C, Sitprija V. Value of skin testing for predicting reactions to equine rabies immune globulin. Clin Infect Dis. 1995 Sep;21(3):660-2. [PubMed] [Google Scholar]
Maharana S, Behera TR, Pattanaik N. Serum sickness in patients receiving equine rabies immunoglobulin. J Commun Dis. 2018;50(2):30-3. [Google Scholar]
World Health Organization [Internet]. WHO guide for rabies pre and post exposure prophylaxis in humans;
[cited 2023 Feb 27]. Available from: https://www.who.int/docs/default-source/searo/india/health- topic-pdf/pep-prophylaxis-guideline-15-12-2014. pdf?sfvrsn=8619bec3_2
Wilde H, Chomchey P, Punyaratabandhu P, Phanupak P, Chutivongse S. Purified equine rabies immune globulin: a safe and affordable alternative to human rabies immune globulin. Bull World Health Organ. 1989;67(6):731-6. [PubMed] [Google Scholar]
