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Along Came A Spider

University doctor helping create a safer antivenom

The screams of the 11-month-old boy could be heard clear across UVA Medical Center's emergency department. His parents were telling Dr. Christopher Holstege their son had grabbed the leggy creature scampering across their kitchen floor. It left two puncture holes on his tiny finger. It was black, they said, had a red hourglass shape on its belly.

Holstege knew the unmistakable marking: a black widow.

He checked the boy. Spasms were beginning to ripple across the skin of his belly and chest, and sweat poured from his hand near the spider's fang marks, a glandular response to the bite. There was antivenom in a cabinet somewhere that could stop it.

But Holstege wouldn't use it.

Instead, he ordered a cocktail of painkillers for the boy—a combination of drugs that would require constant critical-care monitoring—and decided to let the venom run its course.

It took two days.

Still, it was the safest treatment, Holstege says. Roughly 40 percent of people given the antivenom for black widow spider bites have allergic reactions to it. That might mean a mild rash, but it also might mean anaphylaxis, a dangerous immune response that could close up a patient's airway in seconds. Bringing back a patient from that can be tough; for an infant, it might be impossible.

That predicament—faced by doctors in emergency rooms across the country hundreds of times a year—might change soon, however. Holstege, the director of the UVA Medical Center's Blue Ridge Poison Center, is helping to investigate the efficacy of new antivenom that is believed to be allergy free.

Dr. Christopher Holstege
The current antivenom is produced by injecting horses with small amounts of the black widow poison. Antibodies that make the horses immune to the venom are then triggered in the horse's blood. The blood is drawn and the antibodies are separated out and made into antivenom.

But the separation process leaves behind horse proteins that can cause allergic reactions. So researchers have begun a new method using sheep, since that process gives a "clean" antivenom, free of any animal proteins.

The new antivenom might not only minimize risks, it could save expensive hospital stays, Holstege says.

"It will likely be more expensive than the current antivenom," Holstege says. "But it will be far cheaper than admitting a patient to intensive care for two or three days."

Luckily, except for the very young and very old, most spider bites, while extremely painful, are not lethal. There were no deaths reported from black widow bites nationally in 2010, the last year data was available, according to the American Association of Poison Control Centers.

The trial ends later this year, and then must pass a Food and Drug Administration review.

How to Fight a Bite

It might be time for generations of Eagle Scouts to turn in their first aid and wilderness survival merit badges: Most of the ways they learned to treat a bite from a venomous creature are completely wrong, according to Dr. Christopher Holstege, director of the UVA Medical Center’s Blue Ridge Poison Control Center. Below are some of the common myths for treatment, and why they can do more harm than good.

  • Do not place a tourniquet near the bite because it will cut off blood to the extremity and lead to damage and potential long term disability.
  • Do not make a cut at the site because you may cut through vital structures such as tendons and nerves and cause permanent damage.
  • Do not try to suck out the venom because it introduces bacteria into the wound and makes the victim more at risk for infection.
  • Do not put ice on the bite because it causes more damage and cellular death.
  • Never, ever try to capture the spider or snake to show the doctor because you may get bitten a second time. “I’ve seen numerous patients bitten two and even three times when trying to capture the snake or spider,” Holstege says. “We don’t need to see it and we will base our therapy on the symptoms the patient develops.  If you want to show us what bit you, take a picture.”

The best treatment, Holstege says, is to call your poison center for advice, and if directed, get to a hospital as quickly as you can.