During an outbreak of type E
foodborne botulism in Cairo in 1991, an investigational equine F(ab')2 "despeciated" heptavalent
botulism immune globulin (dBIG) was provided to the Egyptian Ministry of Health by the U.S. Army. Of 54 patients known to have been treated with
antitoxins, 4 received commercially available trivalent
antitoxins, 45 received dBIG, and 5 received both commercial
antitoxin and dBIG. Physicians recorded side effects in 10 (22%) of 45 patients who received dBIG; in nine cases, reactions were considered "mild," and in one case they were believed to be
serum sickness. In contrast, possible
serum sickness during hospitalization was recorded for two of four patients who were receiving commercial
antitoxins. No complications of
therapy were noted for any patient who was receiving both
antitoxin types. In a separate study, 31 patients were contacted about their reactions to the
antitoxin by telephone after discharge from the hospital. Seven (54%) of 13 patients attributed symptoms that they experienced while they were hospitalized to receipt of dBIG, while four (44%) of nine patients who indicated that they had received commercial
antitoxins and one (20%) of five who received both commercial
antitoxin and dBIG reported side effects before discharge. Data on the efficacy of the
antitoxins were not obtained. In our experience, equine dBIG was at least as safe as commercially available
antitoxins in treating type E
foodborne botulism.