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Lack of spider anti-venom hurts bitten La Jolla woman

Female Black Widow spider guarding an egg case
Female Black Widow spider guarding an egg case
(wikicommons)

On Friday, March 25, Diane Berol was watering the plants in her garden on Avenida Las Ondas when she felt a stinging pain in her left arm. She thought she was having a heart attack.

“In that moment I’m thinking to myself, ‘I have to finish watering the big tree, this is the last one,’ ” she said. “And my other thought is, ‘If you keep watering this big tree and you die from a heart attack, then he’s going to die because no one is going to be here to water him.’ ”

Diane Berol poses with the gardening glove that sheltered the Black Widow spider inside, which bit her.
Diane Berol poses with the gardening glove that sheltered the Black Widow spider inside, which bit her.
(John Berol)

The 60-year-old La Jollan was then rushed to the emergency room of Scripps Hospital, where she was diagnosed with a Black Widow spider bite between the fingers of her left hand.

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But the highly effective treatment for Black Widow bites, Antivenin, is not available at any hospital in San Diego and since 2009, intermittent shortages have been reported nationwide by the American Society of Health-System Pharmacists (ASHP). Diane said she didn’t know when she refused a painkiller shot at the hospital that she was going to suffer one of the most excruciating experiences known to man.

“The emergency room doctor didn’t tell me what I was in for,” she said. “She didn’t tell me that I was going to be in pain for 48 hours.”

The pain from a Black Widow’s bite has been described as “cramping.” It starts at the bitten spot and spreads throughout the body.

Close up of Black Widow spider bite on Berol’s hand
Close up of Black Widow spider bite on Berol’s hand
(John Berol)

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“The first night, I couldn’t sleep at all, the pain was acute in my hand. I wasn’t crying. I wasn’t screaming. I was just in agony,” Diane said.

Merck, the company that typically manufactures the Black Widow spider anti-venom in the United States, stopped making it a few years ago. The medicine could help dissipate the pain within 15 minutes.

Diane’s husband, John Berol, said he contacted the ASHP to inquire about the missing remedy. AHSP staff member Bona Benjamin replied via e-mail that they had reported the shortage, but considered it solved in February. However, Diane was sent home on March 25 without an Antivenin shot.

Dr. Richard Clark, medical director of the Poison Control Center in San Diego, confirmed the recurring national shortage. “The company doesn’t want to make it anymore. (I guess) they don’t feel like they are making enough money by making it,” Clark said.

But Merck, the pharmaceutical company that produces the Antivenin said it resumed the manufacturing in January. “As of January 2016, there is no longer a limited distribution in place,” wrote Merck’s spokesperson Pamela Eisele via e-mail. “Prior to then, Merck was carefully managing inventories of Antivenin and shipping this product only for patients with symptomatic bites, within 24 hours of notification.”

The only way to get a dose of the Antivenin was if a hospital requested it of the company, which shipped the remaining supplies from previous years within 24 hours. Only in extreme cases will a medical center solicit the remedy.

Dr. Clark said he participated in a clinical study with the Mexican company, Biclon, to test another anti-venom, Analatro. The product is currently in Phase 3 of the Food and Drug Administration approval process, which could take years to complete.

But the average Black Widow spider bite doesn’t require any special treatment other than over-the-counter analgesics, Dr. Clark said, adding, “If your pain gets really bad, then you should go to a hospital.”

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Different individuals have different reactions to a Black Widow’s bite. The number of bites and the amount of venom introduced are other factors in the intensity of pain.

Diane discovered she was bit by a Black Widow who had nested in her gardening gloves. When she put them on to cut roses, the initial prick felt similar to one from a rose thorn, she recalled. “It’s said that the more you pinch the Black Widow, the more venom it pinches into you. I believe that it must have been pretty frightened when I stuck my hand it there. It had nowhere to go,” she said.

Black Widows usually don’t bite humans, said Dr. Clark. “When they are threatened, they will (bite) and it’s usually when people get near their webs and start disturbing them.”

The population of Black Widows in Southern California has diminished in the last decade due to a takeover by one of its relatives. The Brown Widow, a smaller and less hazardous spider, is occupying the niche.

Black Widows go out at night, and during the day hide in dark places. Dr. Clark recommends being careful outside, especially around those spots where spiders might nest or create their webs.

As a precaution going forward, the Berol family said they won’t leave any items outside that a spider might crawl into.

The Black Widow bite is rarely lethal. Only in cases where the patient had an allergic reaction to the anti-venom have deaths been reported in the United States.

If you think you’ve been bit by a Black Widow spider, contact the California Poison Control System 24-hour hotline at (800) 222-1222 for treatment recommendation.

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