Antivenom for European Vipera species envenoming

Abstract

There are very limited pre-clinical comparative data and no randomised controlled trials assessing effectiveness of the antivenoms against different Vipera species. Most descriptive data suggest the efficacy of Zagreb, ViperFAV and ViperaTAb antivenoms by the intravenous route but not intramuscular route, although this is level D evidence. Reported adverse reactions were rare, suggesting that the modern intravenous antivenoms are of good quality. Better and more systematic data, including perhaps randomized controlled trials comparing different antivenoms, are required for the many hundreds of antivenom administrations that occur annually across Europe.

Interventions for the management of snakebite envenoming: An overview of systematic reviews

“…Overall, we evaluated 24 full texts and finally included 13 completed SRs [ 13 – 25 ]. We identified three ongoing SRs which have protocol available in PROSPERO or are published [ 26 – 28 ] which meet our inclusion criteria.…”

“…Effectiveness and safety of SAVs : Six SRs evaluated different types of SAV for envenoming taking a snake species or genus specific approach [ 14 , 16 , 17 , 19 , 24 , 25 ], while three took a more broad non-species-specific approach [ 20 , 22 , 23 ].…”

“…The SR found 40 studies (excepting pre-clinical studies which were included) on various types of anti-European Vipera spp antivenoms involving about 2602 participants [ 25 ]. There were 14 studies each on Zagreb (n = 1306), and on ViperaTAb (n = 197), 11 studies on ViperFAV (n = 558), three studies on Biomed (n = 43), two studies on Bulbio antivenom (n = 69), and one case-report on Viekvin (n = 1).…”

“…Seven included SRs did not conduct any quality appraisal of included studies [ 14 , 18 , 19 , 22 , 24 , 25 , 30 ]. The study on low-dose versus high dose of SAV reported that they used the Cochrane tool and reported that the included trials were of “moderate quality” [ 20 ].…”

Application of the 3R Concept in the Production of European Antiviperinum on Horses – Multisite, Low Volumes Immunization Protocol and Elisa

“…According to World Health Organization [4], three of them (V. ammodytes, V. berus and V. aspis) belong to category 1 ("Category of highest medical importance"), which consist of "Highly venomous snakes that are common or widespread and cause numerous snakebites, resulting in high levels of morbidity, disability or mortality". Although European snake venoms have relatively mild potency compared to snake venoms from other continents [5], their bite can still cause signifi cant impacts. The best way to treat snake bites is by use of antivenom, which are usually F(ab)' 2 fragments or whole IgG purifi ed from horse antiserum.…”