Seltzer Justin A, Winkler Garret A, Hardin Jeremy, Galust Henrik, Albertson Timothy E, Vohra Rais, Smollin Craig, Castillo Edward, Lasoff Daniel, Clark Richard F
Department of Emergency Medicine, UC San Diego Health, San Diego, CA, USA; San Diego Division, California Poison Control System, San Diego, CA, USA.
BeiGene USA, Inc, San Diego, CA, USA.
Am J Emerg Med. 2025 Jan;87:28-31. doi: 10.1016/j.ajem.2024.10.016. Epub 2024 Oct 18.
Rattlesnake envenomations account for many of the Crotalid envenomations in the United States annually. Two antivenoms are currently available to treat Crotalid envenomation in this country: Crotalidae-polyvalent ovine immune Fab antivenom (CroFab®; FabAV) and Crotalidae equine immune F(ab')₂ antivenom (ANAVIP®; F(ab')₂AV). Few studies have compared the adverse effect rates for each. We performed a retrospective chart review of rattlesnake envenomations called to the California Poison Control System from October 2018 to August 2022. Those treated at healthcare facilities with either antivenom were included. Those treated with both antivenoms were excluded. Records were obtained from the poison center electronic medical records system. Demographic and clinical data were abstracted. "Severe" adverse events were defined as multi-organ system involvement, swelling of the patient's airway, and/or hemodynamic instability. All others were categorized as "non-severe." A total of 481 cases were included with 360 treated with FabAV and 121 with F(ab')₂AV. The median age was 47 and 46 years, and 72 % and 73 % were male, respectively. Clinical signs and symptoms of envenomation were similar in each group. The FabAV group received a median of six vials. The F(ab')₂AV group received a median of 10 vials, based on the recommended loading doses of FabAV and F(ab')AV. Following antivenom administration, 18 individual acute non-severe AEs were reported in 12 FabAV-treated patients. Two acute non-severe AEs were reported in two F(ab')₂AV-treated patients. Rash or urticaria was the most commonly reported adverse effect in both groups after antivenom administration. Five patients (1.5 %) had severe adverse events reported in the poison center records following FabAV administration, and none were reported following F(ab')₂AV administration (p = 0.025). Overall, our poison center data suggests the rate of adverse events is low following the use of either antivenom. Our findings are limited by the lack of consistent timing data, a smaller F(ab')₂AV cohort, retrospective format, and use of poison center data.
每年在美国，响尾蛇咬伤导致的中毒事件占蝰蛇科中毒事件的很大一部分。目前有两种抗蛇毒血清可用于治疗该国的蝰蛇科中毒：多价羊免疫Fab抗蛇毒血清（CroFab®；FabAV）和马免疫F(ab')₂抗蛇毒血清（ANAVIP®；F(ab')₂AV）。很少有研究比较过每种抗蛇毒血清的不良反应发生率。我们对2018年10月至2022年8月期间拨打加利福尼亚中毒控制系统电话的响尾蛇咬伤中毒事件进行了回顾性病历审查。纳入了在医疗机构接受任何一种抗蛇毒血清治疗的患者。排除了接受两种抗蛇毒血清治疗的患者。记录从毒物中心电子病历系统获取。提取了人口统计学和临床数据。“严重”不良事件定义为多器官系统受累、患者气道肿胀和/或血流动力学不稳定。所有其他事件归类为“非严重”。总共纳入了481例病例，其中360例接受了FabAV治疗，121例接受了F(ab')₂AV治疗。中位年龄分别为47岁和46岁，男性分别占72%和73%。每组中毒的临床体征和症状相似。FabAV组的中位用药量为6瓶。根据FabAV和F(ab')₂AV的推荐负荷剂量，F(ab')₂AV组的中位用药量为10瓶。抗蛇毒血清给药后，12例接受FabAV治疗的患者报告了18例个体急性非严重不良反应。2例接受F(ab')₂AV治疗的患者报告了2例急性非严重不良反应。皮疹或荨麻疹是两组抗蛇毒血清给药后最常报告的不良反应。在毒物中心记录中，5例患者（1.5%）在接受FabAV治疗后报告了严重不良事件，而接受F(ab')₂AV治疗后未报告严重不良事件（p = 0.025）。总体而言，我们毒物中心的数据表明，使用任何一种抗蛇毒血清后的不良反应发生率都很低。我们的研究结果受到缺乏一致的时间数据、较小的F(ab')₂AV队列、回顾性研究形式以及使用毒物中心数据的限制。
