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Antivenom anaphylaxis

Kaelyn E Petras, Raegan J Wells, Jocelyn Pronko
OBJECTIVE: to describe the clinical presentation of two canines present in anaphylactic shock secondary to rattlesnake envenomation. In both cases, there was no previous documented previous envenomation event and the initial sensitization required for anaphylactic response is believed to be secondary to Crotalus atrox toxoid vaccine. CASE DESCRIPTION: In the first case, a 12-year-old golden retriever present for collapse, severe hematochezia, and vomiting after first time envenomation from a suspected western diamondback rattlesnake...
December 14, 2017: Toxicon: Official Journal of the International Society on Toxinology
Seyed Shahmy, Senanayake A M Kularatne, Shantha S Rathnayake, Andrew H Dawson
INTRODUCTION: Sri Lanka records substantial numbers of snakebite annually. Primary rural hospitals are important contributors to health care. Health care planning requires a more detailed understanding of snakebite within this part of the health system. This study reports the management and epidemiology of all hospitalised snakebite in the Kurunegala district in Sri Lanka. METHODOLOGY: The district has 44 peripheral/primary hospitals and a tertiary care hospital-Teaching Hospital, Kurunegala (THK)...
August 2017: PLoS Neglected Tropical Diseases
Justin Rizer, Kaitlin Brill, Nathan Charlton, Joshua King
Crotalidae polyvalent immune Fab antivenom (CroFab), commonly used for the treatment of clinically significant North American crotalinae envenomation, is generally well-tolerated. A novel form of anaphylaxis due to an IgE antibody response to the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal) has been established following red-meat consumption as well as IV administration of cetuximab, which contain the α-gal epitope. We present a case of α-gal allergy discovered after acute hypersensitivity reaction to FabAV...
August 2017: Clinical Toxicology
Kirsten B Hornbeak, Paul S Auerbach
Venomous aquatic animals are hazardous to swimmers, surfers, divers, and fishermen. Exposures include mild stings, bites, abrasions, and lacerations. Severe envenomations can be life threatening. This article reviews common marine envenomations, exploring causative species, clinical presentation, and current treatment recommendations. Recommendations are included for cnidaria, sponges, bristle worms, crown-of-thorns starfish, sea urchins, venomous fish, stingrays, cone snails, stonefish, blue-ringed octopus, and sea snakes...
May 2017: Emergency Medicine Clinics of North America
Thomas Lamb, Luc de Haro, Davide Lonati, Miran Brvar, Michael Eddleston
BACKGROUND: European viper bite is relatively uncommon but can cause serious envenoming, particularly swelling and hemorrhage spreading from limb to trunk that can cause long term disability. Systemic features are relatively mild compared to many other venomous species. Moderate-to-severe envenoming requires antivenom, which is given many hundreds of times each year across the continent. Several Vipera spp antivenoms are produced in Europe, but there is little comparative information available for the antivenoms and none is licensed with the European Medicines Agency...
July 2017: Clinical Toxicology
G K Isbister, S Jayamanne, F Mohamed, A H Dawson, K Maduwage, I Gawarammana, D G Lalloo, H J de Silva, F E Scorgie, L F Lincz, N A Buckley
Essentials Russell's viper envenoming is a major health issue in South Asia and causes coagulopathy. We studied the effect of fresh frozen plasma and two antivenom doses on correcting coagulopathy. Fresh frozen plasma did not hasten recovery of coagulopathy. Low-dose antivenom did not worsen coagulopathy. SUMMARY: Background Russell's viper (Daboia russelii) envenoming is a major health issue in South Asia and causes venom-induced consumption coagulopathy (VICC). Objectives To investigate the effects of fresh frozen plasma (FFP) and two antivenom doses in correcting VICC...
April 2017: Journal of Thrombosis and Haemostasis: JTH
J C Menon, J K Joseph, M P Jose, B L Dhananjaya, O V Oommen
INTRODUCTION: Snakebite is an occupational hazard causing considerable morbidity and mortality worldwide, particularly so in tropical countries like India. OBJECTIVE: The aim of this study is to (i) review the demographic, clinical and laboratory findings in patients (1051) admitted with venomous snakebite (ii) to correlate mortality, morbidity and duration of hospital stay with clinical signs, symptoms and laboratory parameters. METHODS: A retrospective study of 1051 patients treated for snakebite over 10 years (2000 - 2009) in Little Flower Hospital, Angamaly, Kerala...
August 2016: Journal of the Association of Physicians of India
Daniel R Lasoff, Anne-Michelle Ruha, Steven C Curry, Cynthia Koh, Richard F Clark
STUDY OBJECTIVE: To evaluate the efficacy and safety of a new F(ab')2 antivenom preparation in the treatment of Crotalinae envenomation in children. METHODS: We present a case series of children younger than 16 years who suffered Crotalinae envenomation and were treated with a new F(ab')2 antivenom. Envenomated children treated with the new antivenom were assessed for efficacy of the product, defined as improvement of any hemotoxicity (hypofibrinogenemia, defined as fibrinogen <150 mg/dL, or thrombocytopenia, defined as platelets <150 000/mm(3)), and the cessation of the advancement of swelling...
October 2016: American Journal of Emergency Medicine
Colin R Tilbury, Janette Verster
Bites from the various species of Atractaspis are a common occurrence in Africa but deaths are very unusual. Of the 19 described species, the clinical effects of the bite of only seven have been described, and in only three (Atractaspis irregularis, Atractaspis microlepidota and Atractaspis engaddensis) have fatalities been documented. A case of envenomation is described following a bite to a finger by Atractaspis corpulenta, which resulted in sudden death approximately two and a half hours later. The victim received antivenom and although anaphylaxis to this cannot be ruled out, we consider it to be unlikely to be the cause of death...
August 2016: Toxicon: Official Journal of the International Society on Toxinology
Inthanomchanh Vongphoumy, Phankham Chanthilat, Phongmany Vilayvong, Joerg Blessmann
Snakebites are a seriously neglected public health problem in Lao PDR. Community-based cross-sectional surveys in two districts of Savannakhet province in Southern Laos revealed an incidence of up to 1105 snakebites per 100,000 persons per year. In contrast the number of snakebite patients treated in district and provincial hospitals are low. In order to improve health care for snakebite victims, antivenom was introduced to Savannakhet provincial hospital in July 2013 and medical staff has been trained in management of venomous snakebites at the same time...
July 2016: Toxicon: Official Journal of the International Society on Toxinology
Michael Schaer, Gareth J Buckley, Bobbi J Conner, Laura C Cuddy, Alessio Vigani, Allison E Vansickle, James G Coisman, Deanna R DeVuyst, Carsten Bandt
This manuscript describes the extended clinical abnormalities that can occur in severe snake envenomation and the clinical signs associated with antivenom hypersensitivity in a 3 yr old dog. Treatment consisted of IV fluid therapy, analgesics, a vasopressor, cardiac antiarrhythmia drugs, and polyvalent pit viper antivenom. Following initial response to treatment, relapse of clinical signs occurred. Most interesting was the recrudescence of clinical signs on day 7 that may have been caused by the release of deposited venom during surgical debridement of necrotic skin...
September 2015: Journal of the American Animal Hospital Association
H Asita de Silva, Nicole M Ryan, H Janaka de Silva
Antivenom is the mainstay of treatment of snakebite envenoming. However, adverse reactions to snake antivenom that is available are common in many parts of the world where snakebite is prevalent. Both acute (anaphylactic or pyrogenic) and delayed (serum sickness type) reactions occur. Acute reactions are usually mild but severe systemic anaphylaxis may develop, often within an hour or so of exposure to antivenom. Serum sickness after antivenom has a delayed onset between 5 and 14 days after its administration...
March 2016: British Journal of Clinical Pharmacology
Jing-Fen Jin, Ling-Ling Zhu, Meng Chen, Hui-Min Xu, Hua-Fen Wang, Xiu-Qin Feng, Xiu-Ping Zhu, Quan Zhou
BACKGROUND: Intravenous (IV), intramuscular (IM), and subcutaneous (SC) are the three most frequently used injection routes in medication administration. Comparative studies of SC versus IV, IM versus IV, or IM versus SC have been sporadically conducted, and some new findings are completely different from the dosage recommendation as described in prescribing information. However, clinicians may still be ignorant of such new evidence-based findings when choosing treatment methods. METHODS: A literature search was performed using PubMed, MEDLINE, and Web of Sciences™ Core Collection to analyze the advantages and disadvantages of SC, IV, and IM administration in head-to-head comparative studies...
2015: Patient Preference and Adherence
Kalana Maduwage, Nick A Buckley, H Janaka de Silva, David G Lalloo, Geoffrey K Isbister
BACKGROUND: Snake venom induced consumption coagulopathy is a major systemic effect of envenoming. Observational studies suggest that antivenom improves outcomes for venom induced consumption coagulopathy in some snakebites and not others. However, the effectiveness of snake antivenom in all cases of venom induced consumption coagulopathy is controversial. OBJECTIVES: To assess the effect of snake antivenom as a treatment for venom induced consumption coagulopathy in people with snake bite...
2015: Cochrane Database of Systematic Reviews
Sean P Bush, Shannon B Kinlaw
We describe an illustrative case of pediatric snake envenomation presenting with a tightly wound tourniquet. A 10-year-old boy presented after a snake bite to the right calf. A tourniquet was in place just below the right knee. The species of snake was unknown. The patient was hemodynamically stable, but the entirety of the right leg distal to the tourniquet was discolored. Over concern for a potential venom bolus effect upon tourniquet removal, the decision was made to start a crotaline Fab antivenom infusion and gradually loosen the tourniquet...
September 2015: Wilderness & Environmental Medicine
Toru Hifumi, Satoshi Fujimi, Takuya Yamagishi, Satoru Arai, Kyoko Sawabe, Akihiko Yamamoto, Manabu Ato, Keigo Shibayama, Akihiko Ginnaga, Nobuaki Kiriu, Hiroshi Kato, Yuichi Koido, Junichi Inoue, Masanobu Kishikawa, Yuko Abe, Kenya Kawakita, Masanobu Hagiike, Yasuhiro Kuroda
BACKGROUND: Redback spiders (Latrodectus hasselti) (RBSs) are venomous spiders that have recently spread to Asia from Australia. Since the first case report in 1997 (Osaka), RBS bites have been a clinical and administrative issue in Japan; however, the clinical characteristics and effective treatment of RBS bites, particularly outside Australia remains unclear. This study aimed to elucidate the clinical characteristics of RBS bites and to clarify the effectiveness of the administration of antivenom for treatment...
2014: Journal of Intensive Care
Toru Hifumi, Atsushi Sakai, Akihiko Yamamoto, Masahiro Murakawa, Manabu Ato, Keigo Shibayama, Hiroshi Kato, Yuichi Koido, Junichi Inoue, Yuko Abe, Kenya Kawakita, Masanobu Hagiike, Akihiko Ginnaga, Yasuhiro Kuroda
BACKGROUND: Rhabdophis tigrinus (Yamakagashi snake) is a rear-fanged colubrid snake present throughout Russia and Asia. Its venom induces life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype. R. tigrinus antivenom manufactured by the immunization of horses to neutralize the venom has the risk of adverse events such as anaphylaxis and serum sickness disease. It should be used when benefit is greater than the risk of adverse effects; however, its efficacy has not been well evaluated...
2014: Journal of Intensive Care
Venkatachalaiah Srinivasa, Mahalingam S Sundaram, Sebastian Anusha, Mahadevappa Hemshekhar, Siddaiah Chandra Nayaka, Kempaiah Kemparaju, Basappa, Kesturu S Girish, Kanchugarakoppal S Rangappa
The classical antivenom therapy has appreciably reduced snakebite mortality rate and thus is the only savior drug available. Unfortunately, it considerably fails to shield the viper bite complications like hemorrhage, local tissue degradation and necrosis responsible for severe morbidity. Moreover, the therapy is also tagged with limitations including anaphylaxis, serum sickness and poor availability. Over the last decade, snake venom metalloproteases (SVMPs) are reported to be the primary component responsible for hemorrhage and tissue degradation at bitten site...
2014: PloS One
Geoffrey K Isbister, Simon G A Brown, Colin B Page, David L McCoubrie, Shaun L Greene, Nicholas A Buckley
Snakebite is a potential medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. Patients should be treated in hospitals with onsite laboratory facilities, appropriate antivenom stocks and a clinician capable of treating complications such as anaphylaxis. All patients with suspected snakebite should be admitted to a suitable clinical unit, such as an emergency short-stay unit, for at least 12 hours after the bite. Serial blood testing (activated partial thromboplastin time, international normalised ratio and creatine kinase level) and neurological examinations should be done for all patients...
December 16, 2013: Medical Journal of Australia
Guillermo León, María Herrera, Álvaro Segura, Mauren Villalta, Mariángela Vargas, José María Gutiérrez
Snake antivenoms are formulations of immunoglobulins, or immunoglobulin fragments, purified from the plasma of animals immunized with snake venoms. Their therapeutic success lies in their ability to mitigate the progress of toxic effects induced by snake venom components, when administered intravenously. However, due to diverse factors, such as deficient manufacturing practices, physicochemical characteristics of formulations, or inherent properties of heterologous immunoglobulins, antivenoms can induce undesirable adverse reactions...
December 15, 2013: Toxicon: Official Journal of the International Society on Toxinology
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