Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Snake Farm, Queen Saovabha Memorial Institute, The Thai Red Cross Society, Bangkok 10330, Thailand.
Toxins (Basel). 2022 Oct 9;14(10):694. doi: 10.3390/toxins14100694.
Antivenom is an essential treatment for snake envenomation; however, early adverse reactions (EARs) are major limitations to its use. We performed a retrospective cross-sectional study using Ramathibodi Poison Center data (January 2016 to December 2017) to clarify the incidence and severity of EARs following different F(ab’)2 antivenoms. Among 1006 envenomed patients, 684 (68%) received antivenom therapy with a total of 1157 doses, mostly green pit viper antivenom. The overall EAR incidence and rate were 22. 5% (154/684) and 15% (173/1157), respectively. The EAR rate following each type of antivenom was >10%, except for Russell’s viper antivenom (2.9%); the severe reaction rate was 2.6% (30/1157). Malayan pit viper bites caused a high incidence of EARs (37.8%) and the highest EAR rate (22.3%). Fifty-two cases developed anaphylaxis. All EARs occurred within 2 h after treatment initiation. No deaths were attributed to EARs. The duration of administration was significantly different between doses of antivenom that induced EARs and those that did not. In conclusion, all types and every dose of antivenom should be infused for 30−60 min. Preparation of resuscitation equipment and continuous clinical observation are crucial for at least 2 h after administration, and prompt treatment should be provided when EARs occur.
抗蛇毒血清是蛇咬伤治疗的重要手段，但早期不良反应（EARs）是其应用的主要限制。我们使用 Ramathibodi 中毒中心的数据（2016 年 1 月至 2017 年 12 月）进行了一项回顾性横断面研究，以阐明不同 F(ab’)2 抗蛇毒血清使用后 EARs 的发生率和严重程度。在 1006 名中毒患者中，684 名（68%）接受了抗蛇毒血清治疗，共使用了 1157 剂，主要是青环海蛇抗蛇毒血清。EAR 的总发生率和发生率分别为 22.5%（154/684）和 15%（173/1157）。除了圆斑蝰抗蛇毒血清（2.9%）外，每种抗蛇毒血清的 EAR 发生率均超过 10%；严重反应发生率为 2.6%（30/1157）。马来亚蝮蛇咬伤导致 EAR 发生率较高（37.8%），EAR 发生率最高（22.3%）。52 例发生过敏反应。所有 EAR 均发生在治疗开始后 2 小时内。没有死亡归因于 EAR。EAR 诱导组和非 EAR 诱导组的抗蛇毒血清给药时间有显著差异。总之，所有类型和每种剂量的抗蛇毒血清都应输注 30-60 分钟。在给药后至少 2 小时内应准备好复苏设备并持续进行临床观察，并应在 EAR 发生时及时提供治疗。
