Generic placeholder image

Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry

Author(s): Ghafar-Ali Mahmoudi, Maryam Ahadi, Ali Fouladvand, Bareza Rezaei, Zahra Bodagh and Peyman Astaraki*

DOI: 10.2174/1871523020666210204143756

DownloadDownload PDF Flyer Cite As
Evaluation of Allergic Reactions Following Intravenous Infusion of Polyvalent Antivenom in Snakebite Patients

Page: [367 - 372] Pages: 6

  • * (Excluding Mailing and Handling)

Abstract

Background: Antivenom is a gold-standard treatment for snakebite envenoming. However, adverse reactions to snake antivenom are common in many parts.

Objective: The aim of this study was to evaluate the allergic reactions following intravenous administration of antivenom sera.

Methods: This was retrospective study conducted on snakebites patients referred to the Rahimi Hospital in Khorramabad. The files of these patients were accessed for demographic data, snakebite-related data, treatment provided, clinical presentation and allergic reaction status as a result of antivenom treatment.

Results: 141 cases were investigated, including 73.8% male and 26.2% female patients. The mean age of the patients was 38.1±17.1 years. Age group 30-39 years accounted for the highest number of snakebite cases (24.1%). A majority of victims (89.4%) were from rural areas. Most of the patients (51.8%) were bitten in the spring and highest number of snakebite were reported in May (39.1%). The most common site of snakebite was lower extremities (50.4%) and upper extremities (44.7%). Among clinical feature of snakebite, pain was the most prevalent in 135 cases (95.7%) followed by swelling (83.7%). The mean antivenom vials used were 6.5±3.7 vials. Allergic reactions occurred in 6 patients (4.26%); reactions were mild in 5 patients and severe in 1 patient. The commonest presentation was maculopapular rash (1.4%) and the least common were headache (0.71%), nausea (0.71%), fever (0.71) and hypotension (0.71%).

Conclusion: Snakebite is one of the significant life-threatening environmental events. Immediate antivenom treatment can reduce mortality however, patients should be carefully monitored for adverse allergic reactions

Keywords: Snakebites, antivenom, allergic reaction, venomous, mortality, life-threatening.

Graphical Abstract

[1]
Vikrant, S.; Jaryal, A.; Parashar, A. Clinicopathological spectrum of snake bite-induced acute kidney injury from India. World J. Nephrol., 2017, 6(3), 150-161.
[http://dx.doi.org/10.5527/wjn.v6.i3.150] [PMID: 28540205]
[2]
Dehghani, R.; Rabani, D.; Panjeh Shahi, M.; Jazayeri, M.; Sabahi Bidgoli, M. Incidence of snake bites in kashan, iran during an eight year period (2004-2011). Arch. Trauma Res., 2012, 1(2), 67-71.
[http://dx.doi.org/10.5812/atr.6445] [PMID: 24396746]
[3]
Warrell, D.A. Guidelines for the management of snake-bites. 2010.
[4]
Zeng, F.-J.; Chen, C.; Liu, M.-H. Allergic reactions to antivenom in a patient bitten twice by the same snake within a month: A rare case report and literature review. Chin. J. Traumatol., 2017, 20(5), 299-302.
[http://dx.doi.org/10.1016/j.cjtee.2016.12.004]
[5]
David, A. Guidelines for the clinical management of snake-bites in the south-east Asia region; World Health Organization, Regional Office for South East Asia: New Delhi, 2005, pp. 1-67.
[6]
Monzavi, S.M.; Afshari, R.; Khoshdel, A.R.; Mahmoudi, M.; Salarian, A.A.; Samieimanesh, F.; Shirmast, E.; Mihandoust, A. Analysis of effectiveness of Iranian snake antivenom on Viper venom induced effects including analysis of immunologic biomarkers in the Echis carinatus sochureki envenomed victims. Toxicon, 2019, 158, 38-46.
[http://dx.doi.org/10.1016/j.toxicon.2018.11.293] [PMID: 30452924]
[7]
Simpson, I.D.; Norris, R.L. Snake antivenom product guidelines in India:“The devil is in the details; Elsevier, 2007.
[8]
Laustsen, A.H.; María Gutiérrez, J.; Knudsen, C.; Johansen, K.H.; Bermúdez-Méndez, E.; Cerni, F.A.; Jürgensen, J.A.; Ledsgaard, L.; Martos-Esteban, A.; Øhlenschlæger, M.; Pus, U.; Andersen, M.R.; Lomonte, B.; Engmark, M.; Pucca, M.B. Pros and cons of different therapeutic antibody formats for recombinant antivenom development. Toxicon, 2018, 146, 151-175.
[http://dx.doi.org/10.1016/j.toxicon.2018.03.004] [PMID: 29534892]
[9]
de Almeida, C.M.C.; da Silva, C.L.; Couto, H.P.; Escocard, Rde.C.; da Rocha, D.G.; Sentinelli, Lde.P.; Kipnis, T.L.; da Silva, W.D. Development of process to produce polyvalent IgY antibodies anti-African snake venom. Toxicon, 2008, 52(2), 293-301.
[http://dx.doi.org/10.1016/j.toxicon.2008.05.022] [PMID: 18621073]
[10]
Monzavi, S.M.; Dadpour, B.; Afshari, R. Snakebite management in Iran: Devising a protocol. J. Res. Med. Sci., 2014, 19(2), 153-163.
[11]
Isbister, G.K.; Brown, S.G.; MacDonald, E.; White, J.; Currie, B.J. Australian Snakebite Project Investigators. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med. J. Aust., 2008, 188(8), 473-476.
[http://dx.doi.org/10.5694/j.1326-5377.2008.tb01721.x] [PMID: 18429716]
[12]
Inamdar, K.; Parhate, S.M.; Randad, R.D. Pharmacotherapeutic study of efficacy, safety and prognostic analysis of anti snake venom serum in snake bite patients. 2017, 6(4), 7.
[http://dx.doi.org/10.18203/2319-2003.ijbcp20171102]
[13]
Zamani-Alavijeh, F. Investigation of temporal pattern of scorpion sting and snakebite incidence in patients referred to Masjedsoleiman’s main hospital, during 24 months from 21 March 2008 to 20 March 2009. Safety Promot. Inj. Prev., 2014, 1(4), 190-197.
[14]
Naik, R.; Tirpude, B.; Khajuria, B. Mortality and morbidity pattern in snake bite at MGIMS Sevagram, Wardha: A rural area. Indian Pract., 1997, 50, 31-35.
[15]
Besharat, M.; Vahdani, P.; Abbasi, F. Reporting A Series of 100 Cases of Snake Bites in Loghman Hospital between 2000-2005. Pajoohandeh Journal, 2008, 13(4), 315-320.
[16]
Jarwani, B.; Jadav, P.; Madaiya, M. Demographic, epidemiologic and clinical profile of snake bite cases, presented to Emergency Medicine department, Ahmedabad, Gujarat. J. Emerg. Trauma Shock, 2013, 6(3), 199-202.
[http://dx.doi.org/10.4103/0974-2700.115343] [PMID: 23960378]
[17]
Raina, S.; Raina, S.; Kaul, R.; Chander, V.; Jaryal, A. Snakebite profile from a medical college in rural setting in the hills of Himachal Pradesh, India. Indian J. Crit. Care Med., 2014, 18(3), 134-138.
[http://dx.doi.org/10.4103/0972-5229.128702] [PMID: 24701062]
[18]
Deshpande, R.P.; Motghare, V.M.; Padwal, S.L.; Pore, R.R.; Bhamare, C.G.; Deshmukh, V.S.; Pise, H.N. Adverse drug reaction profile of anti-snake venom in a rural tertiary care teaching hospital. J. Young Pharm., 2013, 5(2), 41-45.
[http://dx.doi.org/10.1016/j.jyp.2013.02.003] [PMID: 24396245]
[19]
Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.; Fonseka, M.M.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J. Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite. Ceylon Med. J., 2002, 47(2), 48-49.
[http://dx.doi.org/10.4038/cmj.v47i2.3451] [PMID: 12140877]
[20]
Williams, D.J.; Jensen, S.D.; Nimorakiotakis, B.; Müller, R.; Winkel, K.D. Antivenom use, premedication and early adverse reactions in the management of snake bites in rural Papua New Guinea. Toxicon, 2007, 49(6), 780-792.
[http://dx.doi.org/10.1016/j.toxicon.2006.11.026] [PMID: 17210167]