Epinephrine is the only prophylactic treatment (pretreatment) that has been shown to effectively reduce the incidence of early adverse reactions (EARs) such as anaphylaxis.60,98,133–136
1. DO NOT pretreat with steroids or antihistamines.
2. DO NOT administer test doses of antivenom to check for hypersensitivity.60–63
Relative contraindications to epinephrine pretreatment include age > 70, hypertension, ischemic heart disease, history of stroke, suspected or confirmed intracranial hemorrhage. No absolute contraindications.
1. Pretreatment with epinephrine prior to antivenom administration is not indicated by default for all antivenoms, and is recommended only under the following circumstances:
2. Standard epinephrine pretreatment protocol: