Is the skin sensitivity test required for administering equine rabies immunoglobulin.
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Date
2011-03
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Abstract
Background. Rabies immunoglobulins are life-saving in
patients with severe exposure to rabies. Despite the high
degree of purification of equine rabies immunoglobulin (ERIG),
the product inserts still recommend a skin sensitivity test
before administration of this heterologous serum. A recent
WHO recommendation states that there are no scientific
grounds for performing a skin test before administering ERIG
because testing does not predict reactions and it should be
given irrespective of the result of the test. In this conflicting
situation, we assessed the use of the skin sensitivity test in
predicting adverse events to ERIG.
Methods. The data analysed were from the Antirabies
Clinic of the Kempegowda Institute of Medical Sciences
Hospital, Bengaluru, India. The period of study was 26 months
(June 2008–July 2010). The skin sensitivity test was validated
by evaluating its sensitivity, specificity, predictability, falsepositive
and false-negative results.
Results. A total of 51 (2.6%) adverse events were
reported in 31 (1.5%) subjects. Most of these were mild to
moderate in nature and subsided without medication. There
was no serious adverse event. The sensitivity and specificity of
the skin sensitivity test to predict an adverse event was 41.9%
and 73.9%, respectively.
Conclusion. Our experience with the skin sensitivity test suggests that it may not be required before administering ERIGs, as recommended by WHO.
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Citation
Sudarshan M K, Narayana D H Ashwath, Ravish H S. Is the skin sensitivity test required for administering equine rabies immunoglobulin. National Medical Journal of India. 2011 Mar-Apr; 24(2): 80-82.