Early Adverse Reactions to Snake Antivenom: Poison Center Data Analysis

Abstract

Antivenom is an essential treatment for snake envenomation; however, early adverse reactions (EARs) are major limitations to its use. We performed a retrospective cross-sectional study using Ramathibodi Poison Center data (January 2016 to December 2017) to clarify the incidence and severity of EARs following different F(ab’)2 antivenoms. Among 1006 envenomed patients, 684 (68%) received antivenom therapy with a total of 1157 doses, mostly green pit viper antivenom. The overall EAR incidence and rate were 22. 5% (154/684) and 15% (173/1157), respectively. The EAR rate following each type of antivenom was >10%, except for Russell’s viper antivenom (2.9%); the severe reaction rate was 2.6% (30/1157). Malayan pit viper bites caused a high incidence of EARs (37.8%) and the highest EAR rate (22.3%). Fifty-two cases developed anaphylaxis. All EARs occurred within 2 h after treatment initiation. No deaths were attributed to EARs. The duration of administration was significantly different between doses of antivenom that induced EARs and those that did not. In conclusion, all types and every dose of antivenom should be infused for 30–60 min. Preparation of resuscitation equipment and continuous clinical observation are crucial for at least 2 h after administration, and prompt treatment should be provided when EARs occur.

Urgent administration of antivenom following proven krait bites in Southeast Asia irrespective of neurotoxic symptoms

“…The recommended dose of the Thai Red Cross is 5 vials of monovalent Malayan or Banded Krait antivenom or 5 vials of Polyvalent neurotoxic antivenom. Although the rate of early adverse reactions is high and can be life-threatening, these reactions are well controlled if appropriate monitoring is in place and adrenaline at hand [11].…”

“…A recent publication from Thailand showed that 154 out of 684 (22.5%) developed early adverse reactions (EARs) and 30 (4.4%) an anaphylactic shock. Under close monitoring during antivenom administration and appropriate treatment of EARs, no death was reported [ 11 ].…”

“…The recommended dose of the Thai Red Cross is 5 vials of monovalent Malayan or Banded Krait antivenom or 5 vials of Polyvalent neurotoxic antivenom. Although the rate of early adverse reactions is high and can be life-threatening, these reactions are well controlled if appropriate monitoring is in place and adrenaline at hand [ 11 ]. In clinical practice, we propose that clinicians should consider administering antivenom to all patients presenting with a confirmed krait bite within the first 6 h after the bite regardless of neurotoxic signs.…”

Characteristic Cases of Snake Bite in Sanjiwani Hospital

“…In their study, they found most of the sample presented with bleeding, in the proportion of (60,4%) and (59,1%). [10], [11], [13], [19] Based on the literature, Zinc Metalloproteinase contained in snake venom is responsible for a spontaneous bleeding incident after a venomous snake bite, also this component is said to have a role in inhibiting platelet aggregation, induced apoptosis, and hemorrhagic effect. Bleeding after a snake bite is also associated with Venom-Induced Consumption Coagulopathy (VICC)., which is marked by a low level of fibrinogen that causes coagulopathy.…”

Revolutionizing snakebite care with novel antivenoms: Breakthroughs and barriers

“…The escalating rates of snakebite-related mortality and amputations in low- and middle-income countries can be attributed to the inadequate availability of antivenoms, substandard healthcare services, variations in antivenom efficacy, and limited ability to mitigate local damage caused by venom variation intra- and interspecifically. Additionally, adverse reactions to antivenom further complicate this issue [ [12] , [13] , [14] , [15] , [16] ].…”