Botulism is a paralyzing illness caused by the action of neurotoxins produced by Clostridium botulinum. One method of management is injection of an equine botulinal antitoxin.
9% of injections (immediate manifestations: 5%, delayed manifestations: 4%).
Anaphylactic shock (occurs even with small amounts of serum): 1.9% of cases;
Urticaria: 2.6% of cases.
Serum sickness (injections exceeding 40 ml): 3.7% of cases.
Generalized erythema, laryngeal edema: 0.7% of cases.
Intradermal skin tests may be positive in patients presenting anaphylactic shock. However, the false negative rate is high (50%) and this test does not rule out the possibility of generalized reactions.
IgE-mediated hypersensitivity probably underlies anaphylactic manifestations, but IgE antibodies have never been demonstrated.
The role of immune complexes is likely in cases involving serum sickness.
No effective prevention for immediate manifestations.
Inject less than 40 ml of botulinal antitoxin so as to minimize serum sickness.
Using botulinal immune globulin obtained from hyperimmunized human donors will be beneficial.