Acute adverse events associated with the administration of Crotalidae polyvalent immune Fab antivenom within the North American Snakebite Registry

Abstract

Background: Crotalidae Polyvalent Immune Fab (Fab Antivenom) is the primary Viperid antivenom used in the United States since 2000. Adverse event data associated with its use are limited. The purpose of this study is to describe the prevalence of acute adverse events associated with the use of Fab antivenom.

Methods: The American College of Medical Toxicology’s Toxicology Investigators Consortium maintains a prospective case registry of poisoned and envenomated patients managed by medical toxicologists at the bedside. This registry includes the North American Snakebite sub-registry. We performed a review of 438 cases entered into the Snakebite sub-registry.

Results: A total of 373 (85.2%) received at least one vial of Fab Antivenom. Forty percent were children. Adverse events occurred in 10 patients (2.7%) of whom six were adults. Rash was the most common adverse event. More severe adverse events (hypotension, bronchospasm, and/or angioedema) occurred in four (1.1%) patients. Prophylaxis was administered prior to Fab antivenom in 4.0%. Eight patients received various treatments for their adverse events. Neither the initial number of Fab antivenom vials, atopic history, nor prior envenomation correlated with the prevalence of adverse events.

Discussion: This prevalence of adverse events was lower than in previous studies and in a meta-analysis of 11 studies. The types of adverse events and treatments used are consistent with those in previous reports. There were no prior reports of prophylaxis use with which to compare.

Conclusion: The prevalence of Fab antivenom adverse events in the North American Snakebite Registry was 2.7%.

Keywords:

• Adverse event
• antivenom
• envenomation
• Fab antivenom
• toxinology

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Corrigendum

Acknowledgements

The authors express gratitude to the staff at the American College of Medical Toxicology (ACMT) for support of the North American Snakebite Registry (NASBR) within this ToxIC Registry project. We would also like to thank the members of the 2015 NASBR group: Anna Arroyo-Plascencia, Vikhyat S. Bebarta, Michael C. Beuhler, William Boroughf, Jeffrey Brent, Daniel Brooks, E. Martin Caravati, James D. Cao, Nathan Charlton, Steven Curry, Michael Darracq, William Dribben, Kimberlie Graeme, Spencer Greene, Benjamin Hatten, Kennon Heard, C William Heise, Janetta Iwanicki, Aaron Min Kang, William P Kerns II, Thomas Kibby, Joshua King, Ronald Kirschner, Kurt Kleinschmidt, Ken Kulig, Michael Levine, Rachel Levitan, Elizabeth Moore, Philip Moore, Michael Mullins, Eleanor Oakley, Ayrn O'Connor, Nancy Onisko, Angie Padilla-Jones, Tammy Phan, Frank LoVecchio, Anne-Michelle Ruha, Steven A. Seifert, Daniel J Sessions, Aaron Skolnik, Eric Smith, Meghan Spyres, An Tran, S. Eliza Halcomb, Evan S. Schwarz, Shawn M. Varney, Rais Vohra, Brandon J. Warrick, Sam G. Wang, Paul Wax, and Brian J. Wolk.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by BTG International Inc, Unrestricted Educational Grant.