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At least 19 recordsLinked to original sources
PubMed1995

Comparison of a new ovine antigen binding fragment (Fab) antivenin for United States Crotalidae with the commercial antivenin for protection against venom-induced lethality in mice.

Snake venom poisoning is a medical emergency requiring immediate attention and the exercise of considerable judgment. Of the estimated 8,000 bites inflicted by venomous snakes in the United States each year, approximately 6,000 are treated with commercial antivenin. The only commercially available antivenin for North American Crotalidae envenomation is Antivenin (Crotalidae) Polyvalent (equine origin) (ACP; Wyeth Laboratories, Philadelphia, PA). A common complication is the high incidence of hypersensitivity reactions, occurring in more than 75% of patients treated with ACP. To minimize these side effects, a novel, affinity-purified, antigen binding fragment (Fab) antivenom (FabAV) for Crotalidae venom poisoning has been produced from the sera of sheep. The new product is Antivenin Polyvalent Crotalid (Ovine) Fab (Crotab; Therapeutic Antibodies, Inc., Nashville, TN). The current report compares the potencies in mice of FabAV and ACP against venom-induced lethality. The results indicate that FabAV is 3.1-9.6 times more potent than ACP for the prevention of lethality of the nine United States venoms tested. For one of the venoms, Crotalus viridis helleri, FabAV was efficacious while ACP was not.

Animals↗
PubMed1957

Survey of assay methods of antivenins; immunological factors influencing antivenin standardization.

In view of the multiplicity of methods used at present for the preparation and assay of antivenins and as a first step towards the international standardization of antivenins, it seemed advisable to make a comparative study of the methods used in the institutes specializing in the production of these sera. With this end in view, the author circulated to the serologists of institutes concerned a detailed questionnaire on the assay methods used for the determination of the neutralization potency of the various types of antivenins prepared under their direction. The information supplied by these institutes is reproduced, in condensed form, in this report and is analysed by the author.THE AUTHOR EMPHASIZES THAT THE GREAT VARIETY IN THE CONSTITUTION OF VENOMS NECESSITATES: (1) the use of monovalent standard sera against homologous "test" venoms of high activity and stability; and (2) the establishment, on a regional basis, of standard antivenins corresponding to groups of snakes characterized by venoms of common or closely related antigenic constitution.

Animals↗
PubMed1976

Immunological properties of antivenins. II. Univalent Naja haje antivenin.

A purified Naja haje antivenin was tested against Egyptian N. haje and N. nigricollis venoms, Indian N. naja venom, Iranian N. naja oxiana, Vipera lebetina, and V. persica venoms, and Echis carinatus venom from both Iran and Egypt. The different elapid venoms, with the exception of that of N. naja oxiana, showed a considerable number of identical and similar precipitin components by immunodiffusion and immunoelectrophoresis. On the other hand, only a few identical and partially identical lines were detected when this antiserum was tested against the viper venoms. Cross neutralization tests in mice showed variable degrees of protection by the antiserum against the different venoms studied; there was no direct correlation with the immunodiffusion results.

Antigen-Antibody Reactions↗
PubMed1985

Ability of a mixture of antimyotoxin a serum and polyvalent (Crotalidae) antivenin to neutralize myonecrosis, hemorrhage and lethality induced by prairie rattlesnake (Crotalus viridis viridis) venom.

Mixtures containing polyvalent (Crotalidae) antivenin and antimyotoxin a serum were tested for their ability to neutralize the myotoxic, hemorrhagic and lethal activities of crude C. v. viridis venom when mixed with the venom prior to injection into white mice. A light microscopic method was used to measure the local myotoxic activity of the venom, i.e. myonecrosis index. The results show that the neutralizing ability of a 1:1 mixture of antisera for myonecrosis was 16 times that of antimyotoxin a serum alone and 63 times that of antivenin alone. There was no difference in neutralizing ability of the three ratios (2:1, 1:1, 1:2) of antivenin: antimyotoxin serum tested. Hemorrhage was measured by a new method in which the amount of hemoglobin in a muscle extract was measured after i.m. injection of test solution. The results show that the ability of a 1:1 mixture to neutralize hemorrhage was comparable to that of antivenin alone. There was no difference in hemorrhage neutralizing ability of the three ratios tested. In its ability to neutralize lethality, the 1:1 mixture was again comparable to antivenin. However, when the three different ratios of antisera were tested for neutralization of lethality the 2:1 and 1:1 ratios were as effective as antivenin alone, whereas the 1:2 ratio (antivenin: antimyotoxin serum) was less effective than antivenin alone. Thus the addition of antimyotoxin a serum to antivenin in equal proportions greatly improves the neutralization of the myotoxic activity of C. v. viridis venom and does not decrease the ability of antivenin to neutralize hemorrhage and lethality.

Animals↗
PubMed2001

Does the aggressive use of polyvalent antivenin for rattlesnake bites result in serious acute side effects?

OBJECTIVE: To determine the incidence and severity of acute side effects from the use of polyvalent antivenin in victims of rattlesnake bites. DESIGN: We retrospectively reviewed the records of all patients who presented with rattlesnake bites to a university teaching hospital during an 11-year period. From patient medical records, we extracted demographic data, clinical measurements, and outcomes during emergency department evaluation and subsequent hospitalization. Data regarding serum sickness were not collected. OUTCOME MEASURES: Primary outcome variables were the occurrence of immediate hypersensitivity reaction to antivenin, the type of reaction, permanent disability at hospital discharge, and mortality. RESULTS: We identified a total of 73 patients with rattlesnake bites during the study period. Bite envenomation was graded as nonenvenomated, 7 patients (10%); mild, 23 patients (32%); moderate, 32 patients (44%); and severe, 11 patients (15%). We identified 65 patients who received antivenin. Antivenin doses ranged from 1 to 30 vials per patient (mean, 12.0 +/- 6.0), for a total of 777 vials. In 43 patients (66%), 10 or more vials of antivenin were given. The mean number of vials of antivenin given to each snakebite grade were as follows: mild, 8.4 (+/-4.0); moderate, 11.8 (+/-5.7); and severe, 18.7 (+/-6.3). No deaths, amputations, or permanent disability from snakebite occurred in the patients receiving antivenin. Acute side effects of antivenin-occurring within the first 6 hours after administration-were seen in 12 patients (18%; 95% confidence interval, 10%-30%). Acute side effects consisted solely of urticaria in all but 1 patient (2%; 95% confidence interval, 0%-8%). This patient had a history of previous antivenin reaction and required a short course of intravenous epinephrine for blood pressure support. No other complications occurred. CONCLUSION: The administration of polyvalent Crotalidae antivenin is safe. Acute hypersensitivity, when it occurs, consists solely in most cases of urticaria. Serious side effects are uncommon.

Adolescent↗
PubMed1999

Efficacy of Wyeth polyvalent antivenin used in the pretreatment of copperhead envenomation in mice.

OBJECTIVES: Wyeth polyvalent crotalid antivenin is the only commercial antivenin available in the United States to treat North American crotalid envenomations. Wyeth antivenin is made from the serum of horses hyperimmunized with four crotalid venoms (Crotalus adamanteus, Crotalus atrox, Crotalus durrisus terrificus, and Bothrops atrox). Although Wyeth antivenin is believed to be effective against all North American crotalids, its efficacy against Agkistrodon contortrix (copperhead) has never been tested. The purpose of this experiment was to determine the efficacy of Wyeth antivenin in the treatment of copperhead envenomation. METHODS: Wyeth antivenin was reconstituted in 10 mL of sterile water. In preliminary experiments, 20 mL/kg of Wyeth antivenin administered intraperitoneally prevented death in mice given a lethal subcutaneous injection of Crotalus adamanteus venom. Freeze-dried copperhead venom was reconstituted in sterile water, and a dose-lethality curve for subcutaneous venom was constructed using seven groups of 10 mice each. The endpoint was survival at 24 hours. A dose that is lethal in 90% of the animals receiving it (LD90) was estimated from this curve. Thirty mice were randomly given pretreatment with 20 mL/kg Wyeth antivenin administered intraperitoneally or an equal volume of normal saline as a control. Thirty minutes later, all mice received an LD90 subcutaneous injection of copperhead venom. Lethality was determined at 24 hours. RESULTS: Following the injection of copperhead venom, none of the 15 control mice and 14 of 15 treatment mice survived until 24 hours (p < 0.001). CONCLUSION: Wyeth antivenin is effective in treating copperhead envenomation in mice and may therefore be expected to be effective in humans.

Agkistrodon↗
PubMed2000

Risk of immediate effects from F(ab)2 bivalent antivenin in Taiwan.

OBJECTIVE: To evaluate the incidence of immediate adverse effects from equine fragment antigen binding F(ab)2 bivalent antivenin produced by the National Institute of Preventive Medicine (NIPM) in Taiwan. METHODS: A retrospective chart review of patients presenting to a 600-bed general hospital over a 3-year period with snakebite who were treated with NIPM antivenin. RESULTS: A total of 130 snakebite victims presented to the emergency department over the study period, and 159 vials of antivenin were given. One hundred two patients (78.5%; 95% CI: 70, 85) received only hemorrhagic bivalent antivenin, 2 (1.5%; 95% CI: 0, 5) received only neurotoxic bivalent antivenin, and the remaining 26 (20.0%; 95% CI: 13, 28) received both kinds of bivalent antivenin. Three received a second vial of hemorrhagic antivenin because of progression of symptoms. Forty-two patients (32.3%; 95% CI: 24, 41) had positive skin tests, but following pretreatment with diphenhydramine and hydrocortisone, only 1 patient developed a skin rash thought to be related to antivenin. No patient developed an anaphylactic reaction. CONCLUSIONS: The use of NIPM F(ab)2 antivenin in snakebite victims in Taiwan has a very low risk of acute adverse reactions.

Adolescent↗
PubMed1991

Effect of inadequate antivenin stores on the medical treatment of crotalid envenomation.

The case of a 27-y-old male with a serious Crotalus atrox envenomation is presented. His medical care was compromised by the lack of readily available polyvalent Crotalidae antivenin. An investigation of antivenin stocking by health care facilities in Arizona was undertaken. Failure to stock sufficient quantities of antivenin to initiate treatment of a single patient with a severe envenomation was found in 43.5% of urban hospitals, 41.2% of rural hospitals within 25 miles of another hospital, 52.9% of rural hospitals greater than 25 miles from another hospital, and 41.7% of Indian Health Service hospitals. Current antivenin stocking was related to antivenin use during the previous year. Reliance on recent antivenin use to guide current antivenin stocking leaves many hospitals with insufficient antivenin stores and may seriously compromise the medical care of patients suffering from rattlesnake envenomations.

Adult↗
PubMed1985

The effect of antivenin on intramuscular pressure elevations induced by rattlesnake venom.

The dose of an antivenin required to neutralize a clinical case of venom poisoning, as well as determining the timing or need to initiate antivenin treatment, is frequently difficult to objectively ascertain. In this study, venom from the southern Pacific rattlesnake, Crotalus viridis helleri, was injected into 29 dog hind limb anterolateral compartments. A solution of C. v. helleri venom (15 mg/ml) was prepared using dessicated venom and saline; 0.2 ml were injected sub-fascially so that each of the compartments received 3 mg of venom. In one group no antivenin was given, in a second group four vials of antivenin were administered i.v. 1 hr post-injection, and in the final group eight vials of antivenin were administered i.v. 1 hr following venom injection. In all groups intracompartment pressures, limb girth and surface temperature were measured at regular intervals over the first 48 hr. In the group receiving eight vials of antivenin the intracompartment pressure reached a peak mean pressure of 49 mm Hg at 2 - 4 hr, and then rapidly fell. In those treated with none or four vials the pressure rose to 70 and 60 mm Hg, respectively, and remained elevated over the first 24 hr. The difference between the former and latter two groups is statistically significant. The findings indicate that the intracompartmental pressure, and presumably destructive damage of the venom, can be controlled by adequate levels of i.v. antivenin. Intracompartmental pressure measurements should be considered as an adjunct in the monitoring and decision-making processes for the treatment of patients bitten by rattlesnakes.

Animals↗
PubMed1991

Poisonous snakebite in central Texas. Possible indicators for antivenin treatment.

Sixty-seven patients hospitalized for poisonous snakebite between 1975 and 1990 were managed by elevation, tetanus prophylaxis, intravenous fluids and antibiotics, and often by a limited excision of the bite site in the Emergency Department, with sequential laboratory studies as needed. Antivenin was used for systemic envenomation, and 23 of the 67 patients (34%) received 133 vials. Thirteen of the twenty-three patients (56%) had adverse reactions to the antivenin. Two significant observations arose. First age was an indicator. Eleven of eighteen patients 12 years or younger (61%) received antivenin, whereas 12 of 49 patients older than 12 years (24%) received antivenin (p = 0.0085, Fisher's exact test). Second species of snake was an indicator. Sixty-two snakes were identified (93%). Of 39 rattlesnake (Crotalus and Sistrurus) bites, 20 patients received antivenin (53%), but of 23 copperhead and water moccasin (Agkistrodon) bites, only three patients (12.5%) received antivenin (p = 0.0025). Antivenin may be indicated for use in systemic rattlesnake envenomation, especially in younger patients.

Adolescent↗
PubMed1997

Management of thai cobra bites with a single bolus of antivenin.

Between January 1981 and December 1991, 68 adults were treated at Chulalongkorn University for cobra bites. Respiratory failure developed in the bite victims even when an adequate genus-specific antivenin was administered at the onset of neuromuscular paralysis. The duration of time spent on a respirator was, however, significantly less in patients treated with an intravenous 100-ml antivenin bolus given at the onset of neurotoxic signs. We found that a bolus of 100 ml of purified equine antivenin produced by the Queen Saovabha Memorial Institute, Bangkok, from Naja kauthia venom was adequate and that increasing the dose did not lead to added benefits. Time spent on a respirator was approximately 10 h in antivenin-treated groups and 40 h if no antivenin or an inadequate dose was used. Competent respiratory and nursing care alone without antivenin will lead to eventual recovery and prevent death. Local bite site tissue necrosis and duration of hospitalization were not related to the dose of antivenin given. Hospitalization was prolonged in subjects who developed sepsis or who had severe tissue necrosis or other surgical or medical complications.

Adolescent↗
PubMed2002

Rattlesnake bites in children: antivenin treatment and surgical indications.

BACKGROUND: Orthopaedic surgeons working in the Americas may be consulted in the care of patients bitten by venomous rattlesnakes (genus Crotalus ), particularly with regard to the possibilities of compartment syndrome and soft-tissue destruction. Despite considerable evidence regarding the safety and efficacy of antivenin in the treatment of rattlesnake bites in adults, controversy persists regarding the roles of antivenin and surgery in the treatment of rattlesnake envenomations in children. Our hypothesis is that aggressive use of antivenin is just as effective and safe for children as it is for adults. METHODS: We retrospectively reviewed the charts of twenty-four consecutive patients who had been managed at our hospital because of a bite from a western diamondback rattlesnake. Nineteen of the twenty-four patients had been envenomated. The uniformity of collected data was facilitated by the use of an intensive-care-unit protocol during the ten-year period that was reviewed. A questionnaire was developed for long-term follow-up. RESULTS: Aggressive use of polyvalent equine antivenin safely prevented the need for surgery in sixteen of the nineteen envenomated patients. Of the three patients who had surgical treatment, two were managed with limited soft-tissue debridement and one was managed with a fasciotomy of the leg because of a compartment syndrome that occurred when adequate antivenin was withheld. No serious adverse effects were noted in association with the antivenin, and no functional impairments were noted at the time of discharge. CONCLUSION: Antivenin, rather than surgery, is the proper initial treatment of severe rattlesnake envenomations in children.

Adolescent↗
PubMed1992

Antivenin administration for Centruroides scorpion sting: risks and benefits.

STUDY OBJECTIVES: To assess the clinical severity of envenomation by the Centruroides scorpion in young children; the potential benefit of antivenin administration with regard to time to resolution of symptoms, prevention of hospitalization, and prevention of invasive intervention; and the risk of acute and delayed hypersensitivity reaction. DESIGN: Retrospective chart review with follow-up contact. SETTING: Referral toxicology management center. TYPE OF PARTICIPANTS: Children less than 10 years of age experiencing severe Centruroides scorpion envenomation. INTERVENTIONS: Administration of goat serum-derived anti-Centruroides antivenin. MEASUREMENTS AND MAIN RESULTS: Stings in young children may be life threatening, resulting in extreme neuromuscular activity, tachycardia, and respiratory distress. Administration of anti-Centruroides antivenin resulted in rapid resolution of all symptoms without acute reaction in all 12 patients so treated; 58% of patients treated with antivenin had a delayed onset of rash or symptoms of serum sickness. CONCLUSION: The benefit of rapid resolution of life-threatening symptoms and potential for outpatient management of severe envenomation in young children may justify the risk of acute and delayed reaction associated with antivenin use in this group. The use of antivenin for the less severe envenomation common in older children and adults may subject them to unjustified risk.

Animals↗