ABSTRACT
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. Ultimately, the prevention reactions will depend mainly on improving the quality of antivenom. Until these overdue improvements take place, doctors will have to depend on pharmacological prophylaxis, where the search for the best prophylactic agent is still on-going, as well as careful observation of patients receiving antivenom in preparation for prompt management of acute as well as delayed reactions when they occur.
Subject(s)
Anaphylaxis/drug therapy , Anaphylaxis/prevention & control , Antivenins/adverse effects , Fever/drug therapy , Fever/prevention & control , Serum Sickness/drug therapy , Serum Sickness/prevention & control , Anaphylaxis/chemically induced , Fever/chemically induced , Humans , Serum Sickness/chemically inducedABSTRACT
The intravenous administration of a 60 ml dose of Vipera palaestinae antivenin was the suggested standard treatment of every bitten patient. In this study 85 Vipera palaestinae bitten patients where selectively treated with antivenin depending on the severity of the clinical picture. Patients who developed systemic or severe local signs received 20 ml of antivenin over 30 min. If symptoms were still present, an additional 10 ml of antivenin was given until systemic signs subsided. Repeated doses of 10 ml of antivenin was administered in each case of systemic symptom relapse. 49% of patients did not exhibit any systemic symptoms and did not receive antivenin treatment. In 63% of antivenin treated cases symptoms were aborted by a single dose of 20 ml of antivenin. 23% of the antivenin treated patients needed 30-40 ml, 19 needed 50-60 ml and only 1 patient (2%) received 80 ml of drug. Serum sickness complications were found in 44% of antivenin treated patients. The results of this study show that antivenin treatment based on systemic symptoms is effective, required less antivenin than the treatment with fixed dose for each patient and reduces the incidence of serum sickness.
Subject(s)
Antivenins/administration & dosage , Serum Sickness/prevention & control , Snake Bites/therapy , Viper Venoms/adverse effects , Viperidae , Adolescent , Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Serum Sickness/pathologyABSTRACT
In the acute serum sickness model in rabbits, we investigated platelet release of 5-HT, platelet surface immunoglobulins, and platelet aggregation in response to ADP, together with the effect of dipyridamole and the Clr antagonist FUT-175. The immune release of 5-HT from platelets occurred between 4 and 6 days after injection of bovine serum albumin (BSA), before immune elimination and proteinuria, but coincident with the appearance of immune complexed BSA in the circulation. Nevertheless, platelet turnovers were not detectably accelerated. Treatment with dipyridamole 50 mg/kg/24 h prevented the release of 5-HT and inhibited proteinuria, glomerular hypercellularity and immune complexes in the glomeruli. Using the Clr antagonist FUT-175, similar abrogation of the disease was obtained. We conclude that in the nephritis of acute serum sickness in rabbits, some of the immune release from platelets may be the result of immune complex binding to the platelet, perhaps through the receptor for C3b.
