Human botulism is of three types depending on how it is acquired: Foodborne illness, wound, and infant botulism. Botulinum toxin causes botulism which is a kind of paralytic illness with symptoms of blurred vision, not being able to speak or drink, and issues in the bilateral upper extremities and this may progress to the chest and lower extremities. It is caused by the bacterial species Clostridium botulinum. Botulinum toxin is one of the most poisonous substances known where its lethal dose is 1nanogram. Initially, the disease was developed in the 70s by the US Army Medical Research Institute of Infectious Diseases (USAMRIID). Also known as botulism antitoxin, it consists of antibodies and antibody antigen-binding fragments which blocks the neurotoxin formed by the bacterial species called Clostridium Botulinum. It is the cause of Botulism. It is also the most poisonous substance known till now.

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What is Botulism & What are Its Symptoms?

Botulism is a paralytic syndrome and it is identified by the symptoms of descending symmetric muscle weakness. Its symptoms include blurry vision, not able to swallow or speak and weakness in the bilateral upper extremities and increases to the chest and lower extremities.

Hypersensitivity Reactions Associated with Botulinum Antitoxin

The Center for Disease Control and Prevention (CDC) observed the reactions of hypersensitivity to botulinal antitoxin of equine origin during an 11-year period between 1967 to 1977.

There were 268 participants in the study. 24 of those participants had nonfatal acute or delayed hypersensitivity reactions to a skin test or therapeutic dose. The total rate of reaction wasn’t different with the age or sex of the participant or with the type of antitoxin administered.

People who received more than 40 ml of serum antitoxin got serum sickness very frequently compared to other people. The reaction rate was higher compared to other people who were associated with other equine serum products and it couldn’t be reduced.

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If botulinal immune globulin which is obtained from hyper-immunized human donors is used, this risk can be reduced if eliminating isn’t possible.

Allergic Reactions of Botulinum Antitoxin

The following allergic reactions are reported to the patients treated with Botulinum Antitoxin:

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  1. Anaphylactic shock
  2. Angioedema
  3. Urticaria

Before the administration of Botulinum Antitoxin, the CDC suggests a test for skin to note the hypersensitivity of the patient. However, epinephrine and other supportive measures for allergic reaction must be easily available. The FDA suggests that if the patient who is prone to an allergic reaction or are highly hypersensitive, should be given Botulinum Antitoxin in less than .01ml per minute.

Adverse Effects of Botulinum Antitoxin

According to the FDA, the following adverse effects have been documented:

  • Infusion Reaction. Reactions may affect any organ system in the body. Most are mild in severity, although severe and even fatal reactions occur. Type 1 hypersensitivity
  • Serum Sickness Syndrome. Type III hypersensitivity reaction.

A patient should be closely monitored after the administration of HBAT because HBAT is an infused equine-derived medication. Symptoms such as chill, fever, headache, malaise, myalgia, and dizziness indicate a reaction of infusion which requires the medication to be stopped or slowing the infusion rate. Sometimes the problem of diabetes may arise as due to the use of botulinum antitoxin because it contains maltose which may interfere with some types of blood glucose monitoring system of the body which may falsely increase the blood glucose reading leading to inappropriate insulin administration or unrecognized hypoglycemia.

Not noticing the action or reaction when the patient is induced to animal proteins which are a type III hypersensitivity known as serum sickness. If the patient is not experienced with antiserum, the reaction will typically happen 2-4 weeks after the administration of the drug. It is difficult to distinguish between the type I and type III hypersensitivity as the symptoms are more or less alike. However, one should always expect serum sickness as a remedy. Steroids and plasmapheresis are among the treatments which decrease inflammation. Other treatments include providing cardiovascular support and clearing the airway. In case the patient has pain in joint, muscle along with fever, swollen glands and rashes over the body for even after 3 weeks of treatment, immediate medical attention must be given.

Though the patient is thoroughly monitored while giving the doses of antibodies as the body contains high risk to show severe allergy symptoms, it can even be fatal if not treated on time. Thus, one should talk to the doctor about the medical history of the patient before taking such high dose antitoxin. The antitoxin is made from horse plasma, therefore sometimes there can be virus transmitted to one’s blood from the blood of the horse. Though the chances are extremely less, one should talk to the doctor about the possible symptoms.

Side Effects of Botulinum Antitoxin

Common Side Effects of Botulinum Toxin

Rare Side Effects of Botulinum Toxin

  • Life-threatening allergic reaction
  • Noisy breathing
  • Stopping of heart
  • Unconsciousness
  • Chest Pain
  • Allergic reaction causing serum sickness
  • Unusual tiredness

Serum Sickness for Botulinum Antitoxin

It is an immune response by the body. It is very similar to an allergic reaction. In rare cases, it can be caused by botulinum antitoxin. There are some substances in certain medications which trigger the responses of the immune system, they are called antigens. Botulinum antitoxin may contain this type of antigens. When antigens and antiserums cause the immune system to react, serum sickness is caused.

Symptoms of Serum Sickness

Usually, serum sickness is caused several days to three weeks after the body is exposed to the medications containing antigens or antiserums. But in some non-frequent cases, it can be seen as fast as one hour after the exposure of the body to antigens or antiserums in some people.

Treatment of Serum Sickness

Usually, serum sickness starts decreasing when the person has stopped using the medications which caused side effects and the body is no longer exposed to those medications. Serum sickness goes away on its own and the period may vary between 1 week to 6 weeks. To improve the condition of the patient the doctor may prescribe some of the medicines to reduce the symptoms of the allergic reaction. These medications include:

  • Anti-inflammatory Drugs. This type of medication includes ibuprofen (Advil). It helps in reducing inflammation, fever, and joint pain.
  • Antihistamines. It helps in reducing rashes and itching,
  • Steroids. This may include prednisone. This is only used if the patient is having very severe symptoms.

Conclusion

Botulism antitoxin consists of antibodies and antibody antigen-binding fragments which blocks the neurotoxin formed by the bacterial species called Clostridium Botulinum. These antigens are the reason for an allergic reaction which leads to serum sickness. Symptoms of serum sickness include diarrhea, itching, and muscle pain. It can be treated with the help of certain medications like anti-inflammatory drugs, antihistamines, and steroids. But steroids are only used in the case of very severe symptoms because they come with various side-effects. It can also be concluded that hypersensitivity reactions can also be caused because of botulinum antitoxin according to the study of the Disease Centre for Control and Prevention (CDC).

References:  

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: May 25, 2019

This article does not provide medical advice. See disclaimer

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