Equine rabies immunoglobulins


In developing countries, equine rabies immunoglobulin (ERIG) is more readily available than human rabies immunoglobulin (HRIG). Modern ammonium-sulfate-precipitated ERIG products are safe and effective.
 
Incidence
Anaphylaxis: 1/35 000.
 
Serum sickness: 1-1,6%.
 
Clinical manifestations
Anaphylactic shock.
 
Generalized urticaria .
 
Bronchospasm.
 
Serum sickness.
 
Diagnostic methods and management
Intradermal skin test must be performed before administration of ERIG (0.02 ml of 1/100 ERIG).
 
If wheal is > 10 mm in diameter with or without flare, or if wheal is 5-10 mm in diameter with a flare > 20 mm; do not use ERIG.
 
False positives have been reported.
 
Mechanisms
Type I hypersensitivity reactions (anaphylaxis).
 
Type III hypersensitivity reactions (serum sickness).

References

  1. Tantawichien T, Benjavongkulchai M, Wilde H, Jaijaroensup W, Siakasem A, Chareowai S, Yountong C, Sitprija V, "Value of skin testing for predicting reactions to equine rabies immunoglobulin", Clin. Infect. Dis. 1995;21 (3): 660-2

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.