Safety profile of snake antivenom (use) in Hong Kong – a review of 191 cases from 2008 to 2015

Mong, Rupeng; Ng, Vember Ch; Tse, ML

doi:10.1080/15563650.2017.1334916

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…Regarding late antivenom reactions, only one case presenting with symptoms compatible with serum sickness was identified in this study, corresponding to an estimated incidence of 2%, which is apparently lower than the 5 to 10% described by other authors 16 , 29 , 36 . This is an important complication related to the administration of immunobiological products attributed to a type III hypersensitivity reaction 16 , 37 .…”

Section: Discussioncontrasting

confidence: 73%

A phase IV, prospective, observational study of the clinical safety of snake antivenoms

Nogueira

Calil

Santos

et al. 2021

Rev. Inst. Med. trop. S. Paulo

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Snake envenoming is a neglected tropical disease that affects more than 2.7 million people worldwide. The treatment is based on the administration of antivenom composed of heterologous immunoglobulins, species-specific therapy involving the possibility of adverse reactions due to activation of the immune system. Considering the scarcity of prospective studies evaluating the safety of snake antivenoms, this study aimed to describe and characterize adverse events after antivenom infusion in an observational, prospective, single-centre investigation conducted in a referral centre in Brazil. A total of 47 victims of snake envenoming were included in the study, who were mostly men (75%), with ages ranging from 2 to 83 years. Twenty-two participants (47%) presented manifestations compatible with infusion-related reactions (IRRs) during or up to two hours after F(ab') 2 heterologous immunoglobulin infusion. The most common clinical manifestation related to the infusion was a diffuse cutaneous rash (82%), followed by respiratory manifestations (46%) and facial swelling (23%). In four cases (9%), IRR were considered serious adverse events (SAE), characterized by haemodynamic instability, airway obstruction or hypoxia. Only one patient developed symptoms compatible with serum sickness. Although almost half of the patients treated with antivenom sera experienced IRRs, the SAE rate was 9%; in all cases, the adverse reaction was reversible by using supportive treatment, and there were no deaths. The results have shown that there is much to improve in the antivenom production process to obtain a more purified and specific product. Even so, a timely antivenom serum administration managed by well-trained health teams is safe and prevents complications after snake-related accidents.

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Section: Discussioncontrasting

confidence: 73%

A phase IV, prospective, observational study of the clinical safety of snake antivenoms

Nogueira

Calil

Santos

et al. 2021

Rev. Inst. Med. trop. S. Paulo

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“…Antivenom adverse reactions were investigated. We confirmed that the following adverse reactions occurred after antivenom administration: nausea, vomiting, diarrhea, dyspnea, hypotension, tachycardia, dizziness, diaphoresis, skin rash, and fever [ 2 , 35 ]. In our study, acute adverse reactions were defined as those occurring within 24 h after the administration of antivenom, and delayed adverse reactions were defined as reactions occurring more than 24 h after the administration of antivenom [ 2 , 16 , 36 , 37 ].…”

Section: Methodssupporting

confidence: 58%

“…Thiansookon et al reported that 2.3% and 12.5% of patients who received lyophilized equine F (ab’)2, species-specific antibodies after being bitten by green pit vipers and cobras experienced adverse reactions [ 34 ]. Mong et al reported that adverse reactions caused by green pit viper antivenom and A. halys antivenom occurred in 4.7% and 1.4% of patients, respectively, in Hong Kong [ 35 ]. According to Kleinschmidt et al, the rate of side effects of Crotalidae Polyvalent Immune Fab in the North American snakebite registry was 2.7%.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been reports that the use of adrenaline can reduce the occurrence of adverse reactions, so it is worth considering adrenaline as a pretreatment in places with high rates of adverse reactions [ 16 , 25 , 40 ]. According to previous studies, the use of antihistamines and corticosteroids has been reported to have no effect as a pretreatment [ 25 , 35 , 41 , 42 , 43 ]. In a randomized controlled trial conducted in Sri Lanka, the rate of administration did not affect the occurrence of adverse reactions [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Adverse Reactions after Administration of Antivenom in Korea

Shim

Kang

Cho

et al. 2020

Toxins

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Kovax® antivenom is the main treatment for toxins produced by the Gloydius species. However, research on adverse reactions after Kovax® antivenom administration is scarce. We aimed to identify the incidence and characteristics of adverse reactions after Kovax® antivenom administration. We conducted a retrospective review of the medical records of snakebite patients in Korea between January 2008 and September 2019. We identified the frequency, characteristics, and treatments of adverse reactions to Kovax® antivenom. There were 150 patients with snakebites, of whom 121 (80.7%) patients received Kovax® antivenom. Adverse reactions occurred in five patients (4.1%). Acute adverse reactions within 24 h of antivenom administration occurred in two patients (1.7%). The symptoms of patients with acute adverse reactions were nausea, diaphoresis, dizziness, and hypotension. Delayed adverse reactions that occurred 24 h after antivenom administration were reported in three patients (2.5%). One patient had a skin rash after 10 days, and two patients had fever 37 and 48 h after antivenom use. In conclusion, most patients were managed safely after Kovax® antivenom, and the incidence of adverse reactions was low. Severe adverse reactions occurred in a small percentage of patients, and there were no deaths.

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“…Envenomation by snake bite from these snakes is a serious public health concern in Asia, and often occur at night when victims are sleeping due to the nocturnal hunting behaviour of these snakes (Alirol et al, 2010;Warrell, 2010). In Hong Kong, victims of bites by B. multicinctus, which produces some of the most potent snake venoms in the world (Gopalkrishnakone and Chou, 1992;Yin et al, 2020), are typically administered an anti-venom specifically designed for the species (Mong et al, 2017). Likewise, patients bitten by B. candidus, which also involves severe and potentially lethal consequences (Trinh et al, 2010;Chaisakul et al, 2017;Charoenpitakchai et al, 2018), are treated with species-specific anti-venoms in Thailand (Leeprasert and Kaojarern, 2007).…”

Section: Discussionmentioning

confidence: 99%

Two Genetically Distinct yet Morphologically Indistinct Bungarus Species (Squamata, Elapidae) in Hong Kong

Yuan

Prigge

Sung³

et al. 2022

Current Herpetology

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Safety profile of snake antivenom (use) in Hong Kong – a review of 191 cases from 2008 to 2015

Abstract: The incidence of immediate hypersensitivity reaction to antivenom commonly used in Hong Kong is low. Majority of patients were managed safely in the emergency department observation ward or general ward. Serum sickness appears to be uncommon and possible cases presented with mild features.

Cited by 12 publications

References 18 publications

A phase IV, prospective, observational study of the clinical safety of snake antivenoms

A phase IV, prospective, observational study of the clinical safety of snake antivenoms

Adverse Reactions after Administration of Antivenom in Korea

Two Genetically Distinct yet Morphologically Indistinct Bungarus Species (Squamata, Elapidae) in Hong Kong

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