“…Like in other studies, limited interventions beyond stopping the infusion and restarting at a slower rate along with antihistamines were necessary to address these reactions. [7][8][9][10][13][14][15] No patients in our analysis were known to have developed a delayed hypersensitivity, or serum sickness, reaction. This differs from the rates observed in previously published postmarketing studies examining F(ab')₂AV.…”
Section: Discussionmentioning
confidence: 95%
“…The total number of vials used is consistent with prior studies in all ages and supports the current age-independent dosing regimen. [8][9][10] F(ab')₂AV seems to be well tolerated in children under real-world conditions. The 2 likely acute hypersensitivity reactions noted in this analysis seemed to be rate-related, as the patients subsequently tolerated infusions at a slower rate, albeit after treatment with antihistamines with or without corticosteroids.…”
Section: Discussionmentioning
confidence: 96%
“…Mascarenas et al showed a 37% (4/11 patients) incidence of delayed hypersensitivity reactions, whereas Ruha et al showed a rate of 10.8% (5/46), and Wilson et al noted a rate of 4.4% (2/45). [8][9][10] It is unclear why we had no documented delayed hypersensitivity reactions. Possible explanations include inadequate power to detect these reactions, insufficient follow-up, and that these reactions are less common in children.…”
Section: Discussionmentioning
confidence: 97%
“…5 Although clinical trial data showed both antivenoms to be effective and generally well tolerated in both adults and children, few postmarketing studies have been published examining F (ab')₂AV. [6][7][8][9][10] Furthermore, no postmarketing study has evaluated F(ab')₂AV for pediatric patients specifically.…”
Objectives
Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab’)₂ antivenom (F(ab’)₂AV; trade name ANAVIP) was introduced in 2018, no pediatric specific studies of F(ab’)₂AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab’)₂AV in children.
Methods
A single-center, retrospective chart review was performed on patients with rattlesnake envenomation presenting to a children's hospital between October 2018 and August 2022. Inclusion criteria were age younger than 18 years and F(ab’)₂AV use. Exclusion criteria were other antivenom use at any time and presentation beyond 24 hours postenvenomation.
Demographic characteristics, hemoglobin, platelet count, fibrinogen, international normalized ratio, number of F(ab’)₂AV vials used, infusion-related complications, and clinical outcomes were collected.
Results
Twenty-six patients, 19 males and 7 females, with a mean age of 7.7 years (0.67 to 16 years) met inclusion criteria. Fourteen (54%) were treated with only the initial 10 vial F(ab’)₂AV doses. Twelve patients were given additional doses with a median additional vials of 10 (4–34 vials; interquartile range, 8.75–12 vials). The median total vials given for all patients was 10 (10–44 vials; interquartile range, 10–20 vials).
Two patients developed acute infusion reactions. Both were treated by slowing the infusion rate and with medications (diphenhydramine, corticosteroids). No delayed reactions were noted. No patients required blood products or surgical interventions.
After discharge, no complications, recurrent symptoms, return visits, or readmissions were reported. Follow-up by chart review or phone was obtained for 18 patients, and no postdischarge complications were noted. Seven patients had postdischarge hematologic laboratory evaluations and all were normal.
Conclusions
Although limited by small sample size and postdischarge follow-up, F(ab’)₂AV was well tolerated in our series of pediatric patients, consistent with prior studies of all age groups.
“…Like in other studies, limited interventions beyond stopping the infusion and restarting at a slower rate along with antihistamines were necessary to address these reactions. [7][8][9][10][13][14][15] No patients in our analysis were known to have developed a delayed hypersensitivity, or serum sickness, reaction. This differs from the rates observed in previously published postmarketing studies examining F(ab')₂AV.…”
Section: Discussionmentioning
confidence: 95%
“…The total number of vials used is consistent with prior studies in all ages and supports the current age-independent dosing regimen. [8][9][10] F(ab')₂AV seems to be well tolerated in children under real-world conditions. The 2 likely acute hypersensitivity reactions noted in this analysis seemed to be rate-related, as the patients subsequently tolerated infusions at a slower rate, albeit after treatment with antihistamines with or without corticosteroids.…”
Section: Discussionmentioning
confidence: 96%
“…Mascarenas et al showed a 37% (4/11 patients) incidence of delayed hypersensitivity reactions, whereas Ruha et al showed a rate of 10.8% (5/46), and Wilson et al noted a rate of 4.4% (2/45). [8][9][10] It is unclear why we had no documented delayed hypersensitivity reactions. Possible explanations include inadequate power to detect these reactions, insufficient follow-up, and that these reactions are less common in children.…”
Section: Discussionmentioning
confidence: 97%
“…5 Although clinical trial data showed both antivenoms to be effective and generally well tolerated in both adults and children, few postmarketing studies have been published examining F (ab')₂AV. [6][7][8][9][10] Furthermore, no postmarketing study has evaluated F(ab')₂AV for pediatric patients specifically.…”
Objectives
Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab’)₂ antivenom (F(ab’)₂AV; trade name ANAVIP) was introduced in 2018, no pediatric specific studies of F(ab’)₂AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab’)₂AV in children.
Methods
A single-center, retrospective chart review was performed on patients with rattlesnake envenomation presenting to a children's hospital between October 2018 and August 2022. Inclusion criteria were age younger than 18 years and F(ab’)₂AV use. Exclusion criteria were other antivenom use at any time and presentation beyond 24 hours postenvenomation.
Demographic characteristics, hemoglobin, platelet count, fibrinogen, international normalized ratio, number of F(ab’)₂AV vials used, infusion-related complications, and clinical outcomes were collected.
Results
Twenty-six patients, 19 males and 7 females, with a mean age of 7.7 years (0.67 to 16 years) met inclusion criteria. Fourteen (54%) were treated with only the initial 10 vial F(ab’)₂AV doses. Twelve patients were given additional doses with a median additional vials of 10 (4–34 vials; interquartile range, 8.75–12 vials). The median total vials given for all patients was 10 (10–44 vials; interquartile range, 10–20 vials).
Two patients developed acute infusion reactions. Both were treated by slowing the infusion rate and with medications (diphenhydramine, corticosteroids). No delayed reactions were noted. No patients required blood products or surgical interventions.
After discharge, no complications, recurrent symptoms, return visits, or readmissions were reported. Follow-up by chart review or phone was obtained for 18 patients, and no postdischarge complications were noted. Seven patients had postdischarge hematologic laboratory evaluations and all were normal.
Conclusions
Although limited by small sample size and postdischarge follow-up, F(ab’)₂AV was well tolerated in our series of pediatric patients, consistent with prior studies of all age groups.
“…1 ). In a recent study from the United States, the median time to antivenom was 3 h, but there was no details on the time to hospital arrival ( Ruha et al, 2022 ). Despite, immediate availability of antivenom in many developed countries, a large proportion of patients still do not receive antivenom within 3 h. Fig.…”
Section: Delays In Antivenom Administrationmentioning
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
