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Antivenom anaphylaxis

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
Shelley F Stone, Geoffrey K Isbister, Seyed Shahmy, Fahim Mohamed, Chandana Abeysinghe, Harendra Karunathilake, Ariaranee Ariaratnam, Tamara E Jacoby-Alner, Claire L Cotterell, Simon G A Brown
BACKGROUND: Snake bite is one of the most neglected public health issues in poor rural communities worldwide. In addition to the clinical effects of envenoming, treatment with antivenom frequently causes serious adverse reactions, including hypersensitivity reactions (including anaphylaxis) and pyrogenic reactions. We aimed to investigate the immune responses to Sri Lankan snake envenoming (predominantly by Russell's viper) and antivenom treatment. METHODOLOGY/PRINCIPAL FINDINGS: Plasma concentrations of Interleukin (IL)-6, IL-10, tumor necrosis factor α (TNFα), soluble TNF receptor I (sTNFRI), anaphylatoxins (C3a, C4a, C5a; markers of complement activation), mast cell tryptase (MCT), and histamine were measured in 120 Sri Lankan snakebite victims, both before and after treatment with antivenom...
2013: PLoS Neglected Tropical Diseases
Ali Karakus, Cem Zeren, M Murat Celik, Secil Arica, Raif Ozden, Mehmet Duru, Veyis Tasın
Snakebites are relatively rare medical emergency cases that might lead to serious consequences. This study aims to evaluate snakebite cases in terms of medical follow-up, antivenom therapy and antivenom reactions. Medical records of patients admitted to emergency department between January 1, 2006 and December 31, 2010 were retrospectively investigated. Snakebite-related cases of a total of 125 patients were included in the scope of the study. Of the total 125 cases, 54.4% were male and 45.6% were female. Most of cases (n: 65, 52%) were aged over 30 years, while the mean age was 34...
February 2015: Toxicology and Industrial Health
S A Brown, S A Seifert, W F Rayburn
CONTEXT: Envenomations during pregnancy pose all the problems of envenomation in the nonpregnant state with additional complexity related to maternal physiologic changes, medication use during pregnancy, and the well-being of the fetus. OBJECTIVE: We review the obstetric literature and management options available to prevent maternal morbidity and mortality while limiting adverse obstetric outcomes after envenomation in pregnancy. METHODS: In January 2012, we searched the U...
January 2013: Clinical Toxicology
Geoffrey K Isbister, S G A Brown
BACKGROUND: Snakebites in snake handlers are an important clinical problem that may differ to bites in the general population. AIM: To investigate the epidemiology and clinical presentation of bites in snake handlers. DESIGN: Prospective observational study. METHODS: Bites in snake handlers recruited as part of the Australian Snakebite Project (ASP) from 2004 to 2011 were included in the study. Data were extracted from the ASP database, which included demographic and clinical information, laboratory tests and antivenom treatment...
November 2012: QJM: Monthly Journal of the Association of Physicians
Geoffrey K Isbister, Margaret A O'Leary, Matthew Elliott, Simon G A Brown
OBJECTIVES: To describe the clinical syndrome associated with definite tiger snake (Notechis spp) envenoming and to examine the ability of tiger snake antivenom (TSAV) to bind free venom in vivo. DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective cohort study within the Australian Snakebite Project, reviewing all definite tiger snake envenoming cases between October 2004 and June 2011. Definite cases were identified by venom-specific enzyme immunoassay or expert snake identification...
August 6, 2012: Medical Journal of Australia
Luc de Haro, Mathieu Glaizal, Lucia Tichadou, Ingrid Blanc-Brisset, Maryvonne Hayek-Lanthois
UNLABELLED: A retrospective case review study of viper envenomations collected by the Marseille's Poison Centre between 1996 and 2008 was performed. RESULTS: 174 cases were studied (52 grade 1 = G1, 90 G2 and 32 G3). G1 patients received symptomatic treatments (average hospital stay 0.96 day). One hundred and six (106) of the G2/G3 patients were treated with the antivenom Viperfav* (2.1+/-0.9 days in hospital), while 15 of them received symptomatic treatments only (plus one immediate death) (8...
December 2009: Toxins
Jaqueline C Funayama, Manuela B Pucca, Eduardo C Roncolato, Thaís B Bertolini, Lucas B Campos, José E Barbosa
The hybrid created from the crossbreeding of European and African bees, known as the Africanised bee, has provided numerous advantages for current beekeeping. However, this new species exhibits undesirable behaviours, such as colony defence instinct and a propensity to attack en masse, which can result in serious accidents. To date, there is no effective treatment for cases of Africanised bee envenomation. One promising technique for developing an efficient antivenom is the use of phage display technology, which enables the production of human antibodies, thus avoiding the complications of serum therapy, such as anaphylaxis and serum sickness...
March 2012: Basic & Clinical Pharmacology & Toxicology
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