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Antivenom (or antivenin, or antivenene) is a biological product used in the treatment of venomous bites or stings. It is created by injecting a small amount of the targeted venom into an animal such as a horse, sheep, goat, or rabbit; the subject animal will suffer an immune response to the venom, producing antibodies against the venom's active molecule which can then be harvested from the animal's blood and used to treat envenomation in others.

Therapeutic use

The principle of antivenom is based on that of vaccines, developed by Louis Pasteur, however instead of inducing immunity in the patient directly, it is induced in a host animal and the hyperimmunized serum is transfused into the patient. The first antivenom for snakes (called an anti-ophidic serum) was developed by Albert Calmette, a French scientist of the Pasteur Institute working at its Indochine branch in 1895, against the Indian Cobra (Naja naja). Vital Brazil, a Brazilian scientist developed in 1901 the first monovalent and polyvalent antivenoms for Central and South American Crotalus, Bothrops and Elaps genera, as well as for certain species of venomous spiders, scorpions, and frogs. They were all developed in a Brazilian institution, the Instituto Butantan, located in São Paulo, Brazil.

Antivenoms can be classified into monovalent (when they are effective against a given species' venom) or polyvalent (when they are effective against a range of species, or several different species at the same time). Antivenoms for therapeutic use are often preserved as freeze-dried ampoules, but some are available only in liquid form and must be kept refrigerated. (They are not immediately inactivated by heat, so a minor gap in the cold chain is not disastrous.) The majority of antivenoms (including all snake antivenoms) are administered intravenously, however stonefish and red back spider antivenoms are given intramuscularly. The intramuscular route has been questioned in some situations as not uniformly effective.

Antivenoms bind to and neutralize the venom, halting further damage, but do not reverse damage already done. Thus, they should be administered as soon as possible after the venom has been injected, but are of some benefit as long as venom is present in the body. Since the advent of antivenoms, some bites which were previously inevitably fatal have become only rarely fatal provided that the antivenom is administered soon enough.

Antivenoms are purified by several processes but will still contain other serum proteins that can act as antigens. Some individuals may react to the antivenom with an immediate hypersensitivity reaction (anaphylaxis) or a delayed hypersensitivity (serum sickness) reaction and antivenom should, therefore, be used with caution. Despite this caution, antivenom is typically the sole effective treatment for a life-threatening condition, and once the precautions for managing these reactions are in place, an anaphylactoid reaction is not grounds to refuse to give antivenom if otherwise indicated. Although it is a popular myth that a person allergic to horses "cannot" be given antivenom, the side effects are manageable, and antivenom should be given as rapidly as the side effects can be managed.See, for example, the Antivenom Precautions paragraph of the Medication section of

Natural and acquired immunity

Although individuals can vary in their physiopathological response and sensitivity to animal venoms, there is no natural immunity to them in humans. Some ophiophagic animals are immune to the venoms produced by some species of venomous snakes, by the presence of antihemorrhagic and antineurotoxic factors in their blood. These animals include King snakes, opossums and hedgehogs.

It is quite possible to immunize a person directly with small and graded doses of venom rather than an animal. According to Greek mythology, King Mithridates did this in order to protect himself against attempts of poisoning, therefore this procedure is often called mithridatization. However, unlike a vaccination against disease which must only produce a latent immunity that can be roused in case of infection, to neutralize a sudden and large dose of venom requires maintaining a high level of circulating antibody (a hyperimmunized state), through repeated venom injections (typically every 21 days). The long-term health effects of this process have not been studied. For some large snakes, the total amount of antibody it is possible to maintain in one human being is not enough to neutralize one envenomation. Further, cytotoxic venom components can cause pain and minor scarring at the immunization site. Finally, the resistance is specific to the particular venom used; maintaining resistance to a variety of venoms requires multiple monthly venom injections. Thus, there is no practical purpose or favorable cost/benefit ratio for this, except for people like zoo handlers, researchers, and circus artists who deal closely with venomous animals. Mithridatization has been tried with success in Australia and Brazil and total immunity has been achieved even to multiple bites of extremely venomous cobras and pit vipers. Starting in 1950, Bill Haast successfully immunized himself to the venoms of Cape, Indian and King cobras.

Because neurotoxic venoms must travel further in the body to do harm, and are produced in smaller quantities, it is easier to develop resistance to them than directly cytotoxic venoms (such as those of most Vipers) that are injected in large quantity and do damage immediately upon injection.

Availability of antivenoms

Antivenom have been developed for the venoms associated with the following animals:

Spiders

Insects

Scorpions

  • Alacramyn: Centruroides limpidus, C. noxius, C. suffusus, Mexico
  • Suero Antialacran: Centruroides limpidus, C. noxius, C. suffusus, Mexico
  • Tunisian polyvalent antivenom: All Iranian scorpions, Tunisia
  • Anti-Scorpion Venom Serum I.P.(AScVS): Indian red scorpion, India
  • Anti-scorpionique: Androctonus spp., Buthus spp., Algeria
  • Scorpion antivenom: Black scorpion, Buthus occitanus, Morocco
  • Soro antiescorpionico: Tityus spp., Brazil
  • SAIMR scorpion antivenom: Parabuthus spp., South Africa

Marine animals

Snakes

No antivenom is yet available against Tetrodotoxin, produced by the blowfish.

Antivenom sources

The following groups assist in locating antivenoms:
  • USA, Miami, Florida: The Miami-Dade Fire Rescue Anti-Venin Bank: Emergency: 1-786-336-6600 available 24 hours. A list of available antivenoms is available at http://www.miami-dadefirerescue.com/modules/AMS/article.php?storyid=13. More information about the bank is available at http://www.venomone.com
  • USA, Oklahoma: Anti-venin index in Oklahoma City, Oklahoma (1-405-271-5454) maintains a 24-hour hotline to help locate rare antivenoms.
  • USA, Colorado: Poisondex central office in Denver, Colorado, USA (1-800-332-3073).
  • Australia: Commonwealth Serum Laboratories, Parkville, Victoria is the source.
  • Asia: Haffkine Biopharmaceutical Corporation, Parel, Bombay, India.
  • Africa: South African Institute for Medical Research, Johannesburg, Republic of South Africa.

References

External links

Toxicology

Antivenin

 

This article is licensed under the GNU Free Documentation License. It uses material from the "Antivenom".

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