Contact Us    Contact Us     |     Feedback
MOBILE VIEW  | 

LATRODECTUS ANTIVENIN

Export To Excel

Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Antivenin (Latrodectus mactans) is derived from a solution of specific venom-neutralizing globulins obtained from the blood serum of healthy horses immunized against venom of black widow spiders. Red back spider antivenom is derived from the plasma of horses immunized with the venom of the female red back spider (Latrodectus hasselti).

Specific Substances

    1) Antivenin, black widow
    2) Antivenin, red back spider
    3) Antivenom, spider
    4) Black widow spider antivenom
    5) Black widow antivenin
    6) Latrodectus antivenom
    7) Latrodectus mactans antivenin
    8) Red back spider antivenom
    9) Red back spider antivenin
    10) Spider-bite antivenom
    11) Spider antivenom
    12) Widow spider species antivenom

Available Forms Sources

    A) FORMS
    1) Latrodectus antivenin is available in the United States as 6000 units injection powder for solution (Prod Info ANTIVENIN IM, IV injection, 2010).
    2) Red back spider antivenom is available as vials containing 500 units of antivenom in 1 to 1.5 mL of aqueous solution (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    B) USES
    1) Latrodectus mactans antivenin is used to treat patients with symptoms due to bites by Latrodectus or widow spiders (Prod Info ANTIVENIN IM, IV injection, 2010).
    2) Red back spider antivenom is used to treat patients who exhibit manifestations of systemic envenoming after a bite by a red back spider (Latrodectus hasselti) (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: Latrodectus mactans antivenin is used to treat patients with symptoms due to bites by Latrodectus or widow spiders. Red back spider antivenom is used to treat patients who exhibit manifestations of systemic envenoming after a bite by a red back spider (Latrodectus hasselti).
    B) PHARMACOLOGY: LATRODECTUS MACTANS ANTIVENIN: The exact mechanism of action is unknown. However, the antivenin specifically binds with and neutralizes circulating venom. Antivenin (Latrodectus mactans) is derived from a solution of specific venom-neutralizing globulins obtained from the blood serum of healthy horses immunized against venom of black widow spiders. RED BACK SPIDER ANTIVENOM: Red back spider antivenom contains specific antibodies that are against the toxic substances in the venom of the red back spider (Latrodectus hasselti). This antivenom is derived from the plasma of horses immunized with the venom of the female red back spider (Latrodectus hasselti). Approximately 5 mg of venom is neutralized by each 500 units (1 vial) of antivenom.
    C) EPIDEMIOLOGY: Envenomations are common; however, overdose from these antivenins are rare.
    D) WITH THERAPEUTIC USE
    1) The primary symptoms seen after use of these antivenins are allergic in nature. An urticarial response may be seen on skin testing or with therapeutic use of Latrodectus antivenom. Both anaphylaxis and serum sickness may develop. Lymphadenopathy, myalgia, rhabdomyolysis, cyanosis, fever, and chest pain have rarely been reported following red back spider antivenom.
    E) WITH POISONING/EXPOSURE
    1) OVERDOSE: No data are available.
    0.2.20) REPRODUCTIVE
    A) The Latrodectus antivenom used in the US is classified as FDA Pregnancy Category C by the manufacturer.
    B) Adequate and well-controlled studies with black widow spider antivenin have not been conducted in humans or in animals and it is unknown whether it can affect reproduction capacity or cause fetal harm. Until further data are available, black widow spider antivenin should be administered to pregnant women only if clearly needed

Laboratory Monitoring

    A) Monitor patients for evidence of acute allergic reactions after administration of antivenin, including rash, wheezing, tachycardia and hypotension.
    B) Monitor for evidence of serum sickness (ie, fever, rash, myalgia, or arthralgias) for 2 to 3 weeks.
    C) Rhabdomyolysis has rarely been reported in patients receiving red back spider antivenom. Monitor CK, renal function, and urine output in patients with rhabdomyolysis.

Treatment Overview

    0.4.6) PARENTERAL EXPOSURE
    A) MANAGEMENT OF TOXICITY
    1) Treatment is symptomatic and supportive.
    B) DECONTAMINATION
    1) Gastrointestinal decontamination is not recommended; administered via the parenteral route.
    C) AIRWAY MANAGEMENT
    1) Perform endotracheal intubation and assist ventilation in patients with severe allergic reactions.
    D) ANTIDOTE
    1) None
    E) HYPERSENSITIVITY REACTION
    1) MILD/MODERATE: Antihistamines with or without inhaled beta agonists, corticosteroids or epinephrine. SEVERE: Oxygen, aggressive airway management, antihistamines, epinephrine, corticosteroids, ECG monitoring, and IV fluids.
    F) SERUM SICKNESS
    1) Treatment should be initiated when the first signs or symptoms appear, usually in 3 to 14 days. Often this will be urticaria and pruritus. Although antihistamines, with and without nonsteroidal anti-inflammatory agents, are often effective for mild symptoms, some patients will progress to more serious effects, and will require steroids.
    a) DIPHENHYDRAMINE: ADULT: 25 to 100 mg/dose IV over 2 minutes; Max 400 mg/day; CHILD: 1.25 mg/kg/dose IV over 2 minutes; Max 300 mg/day.
    b) PREDNISONE: ADULT: Prednisone 40 to 60 mg/day for 5 to 7 days; CHILDREN: 0.5 to 1 mg/kg/day for 5 to 7 days. Steroids should be continued for 24 hours after signs and symptoms have disappeared (usually about 7 days). Tapering is generally not required after short courses of steroids.
    G) RHABDOMYOLYSIS
    1) Administer sufficient 0.9% saline to maintain urine output of 2 to 3 mL/kg/hr. Monitor input and output, serum electrolytes, CK, and renal function. Diuretics may be necessary to maintain urine output. Urinary alkalinization is NOT routinely recommended.
    H) PATIENT DISPOSITION
    1) HOME CRITERIA: Antivenom is generally administered in a hospital setting. There is no data to support home management.
    2) OBSERVATION CRITERIA: Patients should be observed in a medical facility until free of symptoms.
    3) ADMISSION CRITERIA: All patients who continue to be symptomatic should be admitted for observation.
    4) CONSULT CRITERIA: Consult a poison center or medical toxicologist for assistance in managing patients with severe toxicity or in whom the diagnosis is not clear.

Range Of Toxicity

    A) TOXICITY: A specific toxic dose has not been established. Therapeutic doses may cause serum sickness or anaphylaxis.
    B) THERAPEUTIC DOSES: ANTIVENIN, LATRODECTUS MACTANS, UNITED STATES: ADULTS AND CHILDREN (12 years of age and older): 1 vial (approximately 2.5 mL) IM, preferably into anterolateral thigh; a second dose may be necessary in some cases. IN SEVERE CASES OR SHOCK AND CHILDREN (under 12 years of age): dilute contents of 1 vial in 10 to 50 mL normal saline and administer IV over 15 min. ANTIVENIN, LATRODECTUS HASSELTI, AUSTRALIA: ADULTS AND CHILDREN: One vial (500 units) given IM. IN SEVERE CASES, use IV route, first diluting the antivenom 1:10 in Hartmann's solution; may be repeated in 2 hours. If no improvement was observed after 3 vials, consider bites from other species.

Clinical Effects

Summary Of Exposure

    A) USES: Latrodectus mactans antivenin is used to treat patients with symptoms due to bites by Latrodectus or widow spiders. Red back spider antivenom is used to treat patients who exhibit manifestations of systemic envenoming after a bite by a red back spider (Latrodectus hasselti).
    B) PHARMACOLOGY: LATRODECTUS MACTANS ANTIVENIN: The exact mechanism of action is unknown. However, the antivenin specifically binds with and neutralizes circulating venom. Antivenin (Latrodectus mactans) is derived from a solution of specific venom-neutralizing globulins obtained from the blood serum of healthy horses immunized against venom of black widow spiders. RED BACK SPIDER ANTIVENOM: Red back spider antivenom contains specific antibodies that are against the toxic substances in the venom of the red back spider (Latrodectus hasselti). This antivenom is derived from the plasma of horses immunized with the venom of the female red back spider (Latrodectus hasselti). Approximately 5 mg of venom is neutralized by each 500 units (1 vial) of antivenom.
    C) EPIDEMIOLOGY: Envenomations are common; however, overdose from these antivenins are rare.
    D) WITH THERAPEUTIC USE
    1) The primary symptoms seen after use of these antivenins are allergic in nature. An urticarial response may be seen on skin testing or with therapeutic use of Latrodectus antivenom. Both anaphylaxis and serum sickness may develop. Lymphadenopathy, myalgia, rhabdomyolysis, cyanosis, fever, and chest pain have rarely been reported following red back spider antivenom.
    E) WITH POISONING/EXPOSURE
    1) OVERDOSE: No data are available.

Vital Signs

    3.3.3) TEMPERATURE
    A) WITH THERAPEUTIC USE
    1) FEVER has rarely been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

Cardiovascular

    3.5.2) CLINICAL EFFECTS
    A) CHEST PAIN
    1) WITH THERAPEUTIC USE
    a) Chest pain has rarely been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

Hematologic

    3.13.2) CLINICAL EFFECTS
    A) LYMPHADENOPATHY
    1) WITH THERAPEUTIC USE
    a) Lymphadenopathy has rarely been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) URTICARIA
    1) WITH THERAPEUTIC USE
    a) A urticarial response may be seen on skin testing or with therapeutic use of Latrodectus antivenom (Kobernick, 1984).
    B) CYANOSIS
    1) WITH THERAPEUTIC USE
    a) Cyanosis has rarely been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

Musculoskeletal

    3.15.2) CLINICAL EFFECTS
    A) MUSCLE PAIN
    1) WITH THERAPEUTIC USE
    a) Myalgia has rarely been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    B) RHABDOMYOLYSIS
    1) WITH THERAPEUTIC USE
    a) Rhabdomyolysis has rarely been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ANAPHYLAXIS
    1) WITH THERAPEUTIC USE
    a) Latrodectus antivenom is derived from horse serum; therefore, individuals sensitive to horse serum may develop immediate (anaphylactic) or delayed (serum sickness) hypersensitivity reactions (Prod Info ANTIVENIN IM, IV injection, 2010; Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004; Binder, 1989).
    b) In one study, a 0.5% rate of anaphylaxis was reported with the Australian Latrodectus antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004; Sutherland & Trinca, 1978). The rate of acute allergic reactions may be higher with the US antivenom (Clark et al, 1992).
    c) Fatal anaphylaxis has resulted from the use of the US Latrodectus antivenin (Clark et al, 1992). This antivenom is derived from equine serum (Koh, 1998).
    d) Five of 44 patients (11%) developed anaphylactic reactions after receiving undiluted red back spider antivenom intravenously. Six of 2073 patients (0.3%) developed anaphylactic reactions after receiving red back spider antivenom intramuscularly (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    B) HYPERSENSITIVITY REACTION
    1) WITH THERAPEUTIC USE
    a) In one study, 4 of 95 patients receiving dilute intravenous red back spider antivenom (RBSAV; median dose, 2 vials; interquartile range; 1 to 2; range 1 to 12) experienced immediate systemic hypersensitivity reactions (generalized erythema and itchiness (n=3); swelling (n=2); dry cough, difficulty swallowing, uvular and soft palate edema (n=1)) (Isbister, 2007).
    b) Hypersensitivity reactions (eg, rash, urticaria, delayed serum sickness, and local injection site reactions) have been reported in patients receiving red back spider antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    C) TRANSFUSION REACTION DUE TO SERUM PROTEIN REACTION
    1) WITH THERAPEUTIC USE
    a) Serum sickness may develop (Prod Info ANTIVENIN IM, IV injection, 2010; Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    b) In one study of 95 patients receiving dilute intravenous red back spider antivenom (RBSAV; median dose, 2 vials; interquartile range; 1 to 2; range 1 to 12), 3 of 32 patients followed for up to 2 weeks developed symptoms consistent with serum sickness (Isbister, 2007).

Reproductive

    3.20.1) SUMMARY
    A) The Latrodectus antivenom used in the US is classified as FDA Pregnancy Category C by the manufacturer.
    B) Adequate and well-controlled studies with black widow spider antivenin have not been conducted in humans or in animals and it is unknown whether it can affect reproduction capacity or cause fetal harm. Until further data are available, black widow spider antivenin should be administered to pregnant women only if clearly needed
    3.20.2) TERATOGENICITY
    A) PREGNANCY CATEGORY
    1) Latrodectus antivenom is classified as FDA Pregnancy Category C by the manufacturer (Prod Info ANTIVENIN IM, IV injection, 2010).
    2) Adequate and well-controlled studies with black widow spider antivenin have not been conducted in humans or in animals and it is unknown whether it can affect reproduction capacity or cause fetal harm. Until further data are available, black widow spider antivenin should be administered to pregnant women only if clearly needed (Prod Info ANTIVENIN IM, IV injection, 2010).
    3.20.4) EFFECTS DURING BREAST-FEEDING
    A) BREAST MILK
    1) It is not known if this agent is secreted in breast milk. Cautions should be taken when administering this agent to lactating women (Prod Info ANTIVENIN IM, IV injection, 2010).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Monitor patients for evidence of acute allergic reactions after administration of antivenin, including rash, wheezing, tachycardia and hypotension.
    B) Monitor for evidence of serum sickness (ie, fever, rash, myalgia, or arthralgias) for 2 to 3 weeks.
    C) Rhabdomyolysis has rarely been reported in patients receiving red back spider antivenom. Monitor CK, renal function, and urine output in patients with rhabdomyolysis.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) No specific lab work (CBC, electrolytes, urinalysis) is needed unless otherwise clinically indicated.
    4.1.3) URINE
    A) URINALYSIS
    1) After use of black widow antivenin, patients should be monitored for signs of serum sickness for up to 2 or 3 weeks (Peter et al, 1991). This would include monitoring for glomerulonephritis (Peter et al, 1991).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.2) DISPOSITION/PARENTERAL EXPOSURE
    6.3.2.1) ADMISSION CRITERIA/PARENTERAL
    A) All patients who continue to be symptomatic should be admitted for observation.
    6.3.2.2) HOME CRITERIA/PARENTERAL
    A) Antivenom is generally administered in a hospital setting. There is no data to support home management.
    6.3.2.3) CONSULT CRITERIA/PARENTERAL
    A) Consult a poison center or medical toxicologist for assistance in managing patients with severe toxicity or in whom the diagnosis is not clear.
    6.3.2.5) OBSERVATION CRITERIA/PARENTERAL
    A) Patients should be observed in a medical facility until free of symptoms.

Monitoring

    A) Monitor patients for evidence of acute allergic reactions after administration of antivenin, including rash, wheezing, tachycardia and hypotension.
    B) Monitor for evidence of serum sickness (ie, fever, rash, myalgia, or arthralgias) for 2 to 3 weeks.
    C) Rhabdomyolysis has rarely been reported in patients receiving red back spider antivenom. Monitor CK, renal function, and urine output in patients with rhabdomyolysis.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) Gastrointestinal decontamination is not recommended; administered via the parenteral route.

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DERMAL DECONTAMINATION
    1) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

Range Of Toxicity

Summary

    A) TOXICITY: A specific toxic dose has not been established. Therapeutic doses may cause serum sickness or anaphylaxis.
    B) THERAPEUTIC DOSES: ANTIVENIN, LATRODECTUS MACTANS, UNITED STATES: ADULTS AND CHILDREN (12 years of age and older): 1 vial (approximately 2.5 mL) IM, preferably into anterolateral thigh; a second dose may be necessary in some cases. IN SEVERE CASES OR SHOCK AND CHILDREN (under 12 years of age): dilute contents of 1 vial in 10 to 50 mL normal saline and administer IV over 15 min. ANTIVENIN, LATRODECTUS HASSELTI, AUSTRALIA: ADULTS AND CHILDREN: One vial (500 units) given IM. IN SEVERE CASES, use IV route, first diluting the antivenom 1:10 in Hartmann's solution; may be repeated in 2 hours. If no improvement was observed after 3 vials, consider bites from other species.

Therapeutic Dose

    7.2.1) ADULT
    A) UNITED STATES ANTIVENIN, LATRODECTUS MACTANS
    1) The manufacturer recommends that either dermal or conjunctival sensitivity testing should be done prior to administration of latrodectus antivenin. Administer contents of 1 vial (approximately 2.5 mL) either intravenously diluted in 50 mL NS over 15 minutes. The antivenin can also be administered IM, preferably into anterolateral thigh, but this route should not be used in patients with severe envenomation. Prompt relief is generally seen after one vial; a second dose may be necessary in some cases (Prod Info ANTIVENIN IM, IV injection, 2010). If there is no response to 2 vials, the diagnosis of Latrodectus envenomation should be reconsidered.
    B) AUSTRALIAN ANTIVENIN, LATRODECTUS HASSELTI
    1) One vial (500 units) given IM (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    2) IN SEVERE CASES, use IV route, first diluting the antivenom 1:10 in Hartmann's solution; may be repeated in 2 hours. If no improvement was observed after 3 vials, consider bites from other species (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    a) PRECAUTIONS: Fatal anaphylaxis may result from the use of Latrodectus antivenin. All patients receiving antivenin require close monitoring in a setting where resuscitation can be performed immediately. Prepare a separate syringe of 1:1000 epinephrine concurrently, as anaphylactic reactions can develop rapidly. Administer 0.3 to 0.5 mL of 1:1000 epinephrine SubQ to a patient with a severe reaction and repeat as necessary (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004; Clark et al, 1992).
    b) PRETREATMENT: Some authors suggest that patients be pretreated with parenteral antihistamines and perhaps SubQ epinephrine before administration of Australian antivenin (Mead & Jelinek, 1993; Mead & Jelinek, 1993; Sutherland, 1992).
    c) DELAYED TREATMENT: In several cases, symptoms were relieved when antivenin was administered from 10 to more than 60 days after presumed red-back spider bites (Pincus, 1994; Banham et al, 1994).
    d) FOLLOW-UP: Serum sickness may occur 1 to 2 weeks following injection (Couser & Wilkes, 1997).
    C) LATRODECTUS MACTANS AND HASSELTI (MEXICAN)
    1) In a murine model, neutralization of United States Latrodectus mactans and L. hesperus venoms was achieved with a Mexican L. mactans antivenom (Bogdan et al, 2001).
    7.2.2) PEDIATRIC
    A) ANTIVENIN, LATRODECTUS MACTANS, UNITED STATES
    1) OLDER THAN 12 YEARS OF AGE: The manufacturer recommends that either dermal or conjunctival sensitivity testing should be done prior to administration of latrodectus antivenin. Administer contents of 1 vial (approximately 2.5 mL) either intravenously diluted in 50 mL NS over 15 minutes. The antivenin can also be administered IM, preferably into anterolateral thigh, but this route should not be used in patients with severe envenomation. Prompt relief is generally seen after one vial; a second dose may be necessary in some cases (Prod Info ANTIVENIN IM, IV injection, 2010). If there is no response to 2 vials, the diagnosis of Latrodectus envenomation should be reconsidered.
    2) UNDER 12 YEARS OF AGE: Dilute contents of 1 vial in 10 to 50 mL NS; administer IV over 15 min, one dose is usually enough (Prod Info ANTIVENIN IM, IV injection, 2010)
    B) ANTIVENIN, LATRODECTUS HASSELTI, AUSTRALIA
    1) One vial (500 units) given IM (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    2) IN SEVERE CASES, use IV route, first diluting the antivenom 1:10 in Hartmann's solution; may be repeated in 2 hours. If no improvement was observed after 3 vials, consider bites from other species (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).
    a) PRECAUTIONS: Fatal anaphylaxis may result from the use of Latrodectus antivenin. All patients receiving antivenin require close monitoring in a setting where resuscitation can be performed immediately. Prepare a separate syringe of 1:1000 epinephrine concurrently, as anaphylactic reactions can develop rapidly. Administer 0.3 to 0.5 mL of 1:1000 epinephrine (0.01 mL/kg in children) SubQ to a patient with a severe reaction and repeat as necessary (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004; Clark et al, 1992).
    b) PRETREATMENT: Some authors suggest that patients be pretreated with parenteral antihistamines and perhaps SubQ epinephrine before administration of Australian antivenin (Mead & Jelinek, 1993; Mead & Jelinek, 1993; Sutherland, 1992).
    c) DELAYED TREATMENT: In several cases, symptoms were relieved when antivenin was administered from 10 to more than 60 days after presumed red-back spider bites (Pincus, 1994; Banham et al, 1994).
    d) FOLLOW-UP: Serum sickness may occur 1 to 2 weeks following injection (Couser & Wilkes, 1997).

Maximum Tolerated Exposure

    A) A specific toxic dose has not been established.

Serum Plasma Blood Concentrations

    7.5.1) THERAPEUTIC CONCENTRATIONS
    A) THERAPEUTIC CONCENTRATION LEVELS
    1) A study compared the antivenom concentrations of red back (widow) spider antivenom in 20 patients after intravenous (n=10) and intramuscular (n=10) administration. After intramuscular injection (5 patients received one vial and 5 patients received 2 vials administered 2 hours apart), antivenom was not detectable in serum at any time point up to 2 hours after the last administered dose. However, after intravenous injection (3 patients received one vial and 7 patients received two or more vials administered 2.5 hours apart) antivenom was detectable in the within 30 minutes after intravenous infusion (Isbister et al, 2008).

Pharmacology Toxicology

Pharmacologic Mechanism

    A) LATRODECTUS MACTANS ANTIVENIN: The exact mechanism of action is unknown. However, the antivenin specifically binds with and neutralizes circulating venom. Antivenin (Latrodectus mactans) is derived from a solution of specific venom-neutralizing globulins obtained from the blood serum of healthy horses immunized against venom of black widow spiders (Prod Info ANTIVENIN IM, IV injection, 2010).
    B) RED BACK SPIDER ANTIVENOM: Red back spider antivenom contains specific antibodies that are against the toxic substances in the venom of the red back spider (Latrodectus hasselti). This antivenom is derived from the plasma of horses immunized with the venom of the female red back spider (Latrodectus hasselti). Approximately 5 mg of venom is neutralized by each 500 units (1 vial) of antivenom (Prod Info RED BACK SPIDER ANTIVENOM intramuscular injection, 2004).

References

General Bibliography

    1) Banham NGD, Jelinek GA, & Finch PM: Late treatment with antivenom in prolonged red-back spider envenomation. Med J Australia 1994; 161:379-381.
    2) Binder LS: Acute arthropod envenomation: incidence, clinical features and management. Med Toxicol Adverse Drug Exp 1989; 4:163-173.
    3) Bogdan GM, Hill RE, & Jolliff HA: Neutralization of United States Latrodectus mactans and L. hesperus venoms with a Mexican L. mactans antivenom (abstract). Clin Toxicol 2001; 39:496.
    4) Brown CV, Rhee P, Chan L, et al: Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?. J Trauma 2004; 56(6):1191-1196.
    5) Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
    6) Camp NE: Drug- and toxin-induced Rhabdomyolysis. J Emerg Nurs 2009; 35(5):481-482.
    7) Clark RF, Wethern-Kestner S, Vance MV, et al: Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med 1992; 21(7):782-787.
    8) Couser GA & Wilkes GJ: A red-back spider bite in a lymphoedematous arm. Med J Aust 1997; 166:587-588.
    9) Criddle LM: Rhabdomyolysis. Pathophysiology, recognition, and management. Crit Care Nurse 2003; 23(6):14-22, 24-26, 28.
    10) Ellis RM, Sprivulis PC, Jelinek GA, et al: A double-blind, randomized trial of intravenous versus intramuscular antivenom for Red-back spider envenoming. Emerg Med Autralasia 2005; 17:152-156.
    11) Erdman AR & Dart RC: Rhabdomyolysis. In: Dart RC, Caravati EM, McGuigan MA, et al, eds. Medical Toxicology, 3rd ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2004, pp 123-127.
    12) Graudins A, Padula M, & Broady K: Red-back spider (Latrodectus hasselti) antivenom prevents the toxicity of widow spider venoms. Ann Emerg Med 2001; 37:154-160.
    13) Homsi E, Barreiro MF, Orlando JM, et al: Prophylaxis of acute renal failure in patients with rhabdomyolysis. Ren Fail 1997; 19(2):283-288.
    14) Huerta-Alardin AL, Varon J, & Marik PE: Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians. Crit Care 2005; 9(2):158-169.
    15) Isbister GK, O'Leary M, Miller M, et al: A comparison of serum antivenom concentrations after intravenous and intramuscular administration of redback (widow) spider antivenom. Br J Clin Pharmacol 2008; 65(1):139-143.
    16) Isbister GK: Safety of i.v. administration of redback spider antivenom. Intern Med J 2007; 37(12):820-822.
    17) Jelinek GA: Widow spider envenomation (latrodectism): A worldwide problem. Wilderness Environ Med 1997; 8:226-231.
    18) Kobernick M: Black widow spider bite. Am Fam Physician 1984; 29:241-245.
    19) Koh WL: When to worry about spider bites. Inaccurate diagnosis can have serious, even fatal, consequences. Postgrad Med 1998; 103:235-250.
    20) Lieberman P, Nicklas R, Randolph C, et al: Anaphylaxis-a practice parameter update 2015. Ann Allergy Asthma Immunol 2015; 115(5):341-384.
    21) Lieberman P, Nicklas RA, Oppenheimer J, et al: The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010; 126(3):477-480.
    22) Mead HJ & Jelinek GA: Red-back spider bites to Perth children, 1979-1988. J Paediatr Child Health 1993; 29:305-308.
    23) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    24) National Heart,Lung,and Blood Institute: Expert panel report 3: guidelines for the diagnosis and management of asthma. National Heart,Lung,and Blood Institute. Bethesda, MD. 2007. Available from URL: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
    25) Nowak RM & Macias CG : Anaphylaxis on the other front line: perspectives from the emergency department. Am J Med 2014; 127(1 Suppl):S34-S44.
    26) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    27) Peter G, Lepow ML, & McCracken: Report of the Committee on Infectious Diseases, 22nd edition, American Academy of Pediatricians, Elk Grove Village, IL, 1991, pp 42-43.
    28) Pincus DR: Response to antivenom 14 days after red-back spider bite (Letter). Med J Aust 1994; 161:226.
    29) Polderman KH: Acute renal failure and rhabdomyolysis. Int J Artif Organs 2004; 27(12):1030-1033.
    30) Product Information: ANTIVENIN IM, IV injection, latrodectus mactans IV, IM injection. Merck Sharp & Dohme Corp. (per manufacturer), Whitehouse Station, NJ, 2010.
    31) Product Information: RED BACK SPIDER ANTIVENOM intramuscular injection, red back spider antivenom intramuscular injection. CSL Limited (per manufacturer), 2004.
    32) Product Information: diphenhydramine HCl intravenous injection solution, intramuscular injection solution, diphenhydramine HCl intravenous injection solution, intramuscular injection solution. Hospira, Inc. (per DailyMed), Lake Forest, IL, 2013.
    33) Product Information: diphenhydramine hcl injection, diphenhydramine hcl injection. Bioniche Pharma USA,LLC, Lake Forest, IL, 2006.
    34) Rauber A: Black widow spider bites. J Toxicol Clin Toxicol 1984; 21:473-485.
    35) Sutherland SK & Trinca JC: Survey of 2144 cases of red-back spider bites. Med J Aust 1978; 2:620-623.
    36) Sutherland SK: Antivenom use in Australia: premedication, adverse reactions and the use of venom detection kits. Med J Aust 1992; 157:734-739.
    37) Vanden Hoek,TL; Morrison LJ; Shuster M; et al: Part 12: Cardiac Arrest in Special Situations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association. Dallas, TX. 2010. Available from URL: http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S829. As accessed 2010-10-21.
    38) Vanholder R, Sever MS, Erek E, et al: Rhabdomyolysis. J Am Soc Nephrol 2000; 11(8):1553-1561.
    39) Walter LA & Catenacci MH: Rhabdomyolysis. Hosp Physician 2008; 44(1):25-31.
    40) White J: Envenoming and antivenom use is Australia. Toxicol 1998; 36:1483-1492.
    41) Wingert WA & Chan L: Rattlesnake bites in southern California and rationale for recommended treatment.. West J Med 1988; 148:37-44.