Antivenin 391320 225619698 2008-07-14T16:17:27Z Rmhermen 835 /* Snakes */ {{for|the Marvel Comics character|Anti-Venom (comics)}} [[Image:Snake Milking.jpg|thumb|right|250px|Milking a snake for the production of antivenom.]] '''Antivenin''' (or '''antivenom''' or '''antivenene''') is a biological product used in the treatment of [[venom (poison)|venomous]] bites or stings. The name comes from the French word [[venin]] meaning [[venom]], and historically the word antivenin was predominant around the world. For the English language the [[World Health Organization]] decided in 1981 that the preferred terminology in the English language would be "venom" and "antivenom" rather than "venin/antivenin" or "venen/antivenene".<ref>{{cite book |last= World Health Organization| first= |title=Progress in the characterization of venoms and standardization of antivenoms |publisher=WHO Offset Publications | location=Geneva |year=1981|pages=5| isbn=9241700580}}</ref> However, it is still called antivenin or antivenene by many organizations today. Antivenin 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 [[antibody|antibodies]] against the venom's active molecule which can then be harvested from the animal's blood and used to treat envenomation in others. Internationally, Snake Venom Antitoxin must carefully meet the standards of [[Pharmacopoeia]] and the [[World Health Organization]] (WHO). [http://www.intervax.com/index.php/antitoxins.html] ==Therapeutic use== The principle of antivenin is based on that of [[vaccine]]s, 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 [[Blood transfusion|transfused]] into the patient. Antivenins 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). The first antivenin 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 antivenins for Central and South American ''[[Crotalus]]'', ''[[Bothrops]]'' and ''[[Elaps]]'' genera, as well as for certain species of venomous [[spider]]s, [[scorpion]]s, and [[frog]]s. They were all developed in a Brazilian institution, the [[Instituto Butantan]], located in [[São Paulo (city)|São Paulo]], [[Brazil]]. Antivenins for therapeutic use are often preserved as [[freeze-dried]] [[ampoule]]s, 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 antivenins (including all snake antivenins) are administered intravenously, however [[stonefish]] and [[redback spider]] antivenins are given [[intramuscularly]]. The intramuscular route has been questioned in some situations as not uniformly effective.<ref name=”EmergMed2002-isbister”>{{cite journal | author=Isbister GK. | title=Failure of intramuscular antivenom in Redback spider envenoming | journal=Emerg Med (Fremantle) | year=2002 | pages=436–9 | volume=14 | issue=4 | pmid=12534488}}</ref> Antivenins 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 antivenins, some bites which were previously inevitably fatal have become only rarely fatal provided that the antivenin is administered soon enough. Antivenins are purified by several processes but will still contain other serum [[protein]]s that can act as [[antigen]]s. Some individuals may react to the antivenin with an immediate hypersensitivity reaction ([[anaphylaxis]]) or a delayed hypersensitivity ([[serum sickness]]) reaction and antivenin should, therefore, be used with caution. Despite this caution, antivenin 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 antivenin if otherwise indicated. Although it is a popular myth that a person allergic to horses "cannot" be given antivenin, the side effects are manageable, and antivenin should be given as rapidly as the side effects can be managed.<ref>See, for example, the Antivenin Precautions paragraph of the Medication section of {{cite web |url=http://www.emedicine.com/emerg/topic543.htm#section~medication |title=Snake Envenomations, Sea |author=James Forster, MD, MS |date=2006-03-14 |work=eMedicine Emergency Medicine (environmental) |accessdate=2006-06-25}}</ref> Sheep are generally used in preference over horses now, however, as the potential for adverse immunological responses in humans from sheep-derived antibodies is generally somewhat less than that from horse-derived antibodies. The use of horses to raise antibodies - in Australia at least, where much antivenin research has been undertaken (by Sutherland and others for example) - has been attributed to the research base originally having been comprised of a large number of veterinary officers. These vets had, in many cases, returned from taking part in the [[Boer War|Boer]] and [[First World War]]s and were generally experienced with horses (eg: cavalry). The large animal vets were similarly oriented given the use of horses as a prime source of motive power and transport, especially in the rural setting. The overall experience with horses naturally made them the preferred subject in which to raise antibodies. It was not until later that the immuno-reactivity of certain horse serum proteins was assessed to be sufficiently problematic that alternatives in which to raise antibodies were investigated.{{Fact|date=February 2007}} ==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 [[ophiophagy|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 snake|King snakes]], [[opossum]]s and [[hedgehog]]s. It is quite possible to immunize a person directly with small and graded doses of venom rather than an animal. According to [[Greek history]], King [[Mithridates VI of Pontus|Mithridates]] did this in order to protect himself against attempts of [[poison|poisoning]], therefore this procedure is often called ''[[mithridatization]]''. However, unlike a [[vaccination]] against disease which must only produce a latent [[immunity (medical)|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 Cobra|Cape]], [[Indian Cobra|Indian]] and [[King Cobra|King]] cobras. Because [[neurotoxic]] venoms must travel farther 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 [[Viperidae|vipers]]) that are injected in large quantity and do damage immediately upon injection. ==Availability of antivenins== Antivenins have been developed for the venoms associated with the following animals:<ref name="Antivenom Tables">{{cite journal |author= |title=Appendix: Antivenom Tables |journal=Clinical Toxicology |volume=41 |issue=3 |pages=317–27 |year=2003|doi=10.1081/CLT-120021117 }}</ref> ===Spiders=== {|class=wikitable ! Antivenin ! Species ! Country |- | Funnel web spider antivenom | [[Sydney funnel-web spider]] | Australia |- | Soro antiaracnidico | [[Brazilian wandering spider]] | Brazil |- | Soro antiloxoscelico | [[Recluse spider]] | Brazil |- | Suero antiloxoscelico | [[Chilean recluse]] | Peru |- | Aracmyn | All species of ''[[Loxosceles]]'' and ''[[Latrodectus]]'' | Mexico |- | Redback spider antivenom | [[Redback spider]] | Australia |- | Black widow antivenin | [[Black widow spider]] | USA |- | SAIMR Spider antivenom | [[Button spider]] | South Africa |- | Anti Latrodectus antivenom | [[Black widow spider]] | Argentina |} ===Acarids=== {|class=wikitable ! Antivenin ! Species ! Country |- | Tick antivenom | [[Ixodes holocyclus|Paralysis tick]] | Australia |} ===Insects=== {|class=wikitable ! Antivenin ! Species ! Country |- | Soro antilonomico | ''[[Lonomia|Lonomia oblique]]'' caterpillar | Brazil |} ===Scorpions=== {|class=wikitable ! Antivenin ! Species ! Country |- | Alacramyn | ''[[Centruroides limpidus]]'', ''[[Centruroides noxius|C. noxius]]'', ''[[Centruroides suffusus|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 (genus)|Tityus]] spp.'' | [[Brazil]] |- | SAIMR scorpion antivenom | ''[[Parabuthus]] spp.'' | [[South Africa]] |- | Purified polyvalent Anti-Scorpion Serum(equine) | ''[[Leiurus]]'' spp.& ''[[Androctons]]'' scorpions | [[Egypt]] |} ===Marine animals=== {|class=wikitable ! Antivenin ! Species ! Country |- | CSL box jellyfish antivenom | [[Box jellyfish]] | Australia |- | CSL stonefish antivenom | [[Stonefish]] | Australia |} ===Snakes=== * Polyvalent snake antivenom: Saw-scaled Viper ''[[Echis carinatus]]'', Russell's Viper ''[[Daboia|Daboia russelli]]'', Spectacled Cobra ''[[Naja naja]]'', Common Krait ''[[Bungarus caeruleus]]'' India * Death adder antivenom: [[Death adder]], Australia * Taipan antivenom: [[Taipan]], Australia * Black snake antivenom: [[Pseudechis|Pseudechis spp.]] Australia. * Tiger snake antivenom: [[Austrelaps|Australian copperheads]], [[Tiger snake]]s, Pseudechis spp., [[Rough scaled snake]]. Australia * Brown snake antivenom: [[Pseudonaja|Brown snakes]], Australia * Polyvalent snake antivenom: Many Australian snakes, Australia * Sea snake antivenom: [[Sea snake]]s, Australia * Vipera tab: [[Vipera]] spp. USA * Polyvalent crotalid antivenin (CroFab - Crotalidae Polyvalent Immune Fab (Ovine)): North American pit vipers (all [[rattlesnake]]s, [[Agkistrodon contortrix|copperhead]]s, and [[cottonmouth]]s), USA * Soro antibotropicocrotalico: [[Crotalinae|Pit vipers]] and rattlesnakes, Brazil * Antielapidico: [[Coral snake]]s, Brazil * Soro anti-elapidico: Coral snakes, Brazil * SAIMR polyvalent antivenom: [[Mamba]]s, [[Naja|Cobras]], [[Rinkhals]]es, [[Bitis|Puff adders]] (Unsuitable small adders: ''[[B. worthingtoni]]'', ''[[Bitis atropos|B. atropos]]'', ''[[Bitis caudalis|B. caudalis]]'', ''[[Bitis cornuta|B. cornuta]]'', ''[[Bitis heraldica|B. heraldica]]'', ''[[Bitis inornata|B. inornata]]'', ''[[Bitis peringueyi|B. peringueyi]]'', ''[[Bitis schneideri|B. schneideri]]'', ''[[Bitis xeropaga|B. xeropaga]]''), South Africa<ref name="SB95">Spawls S, Branch B. 1995. The Dangerous Snakes of Africa. Ralph Curtis Books. Dubai: Oriental Press. 192 pp. ISBN 0-88359-029-8.</ref> * SAIMR echis antivenom: [[Echis|Saw-scaled vipers]], South Africa * SAIMR Boomslang antivenom: [[Boomslang]], South Africa * Panamerican serum: anticoral polyvalent serum: Coral snakes, Costa Rica * Anticoral: Coral snakes, Costa Rica * Anti-mipartitus antivenom: Coral snakes, Costa Rica * Anticoral monovalent: Coral snakes, Costa Rica * Antimicrurus: Coral snakes, Argentina * Coralmyn: Coral snakes, Mexico * Anti-micruricoscorales: Coral snakes, Colombia ==Antivenin sources== The following groups assist in locating antivenins: * [[Africa]]: South African Institute for Medical Research, [[Johannesburg]], [[Republic of South Africa]]. * [[Asia]]: Haffkine Biopharmaceutical Corporation, [[Parel]], [[Mumbai]], [[India]]. * [[Australia]]: [[CSL Limited]], [[Parkville, Victoria|Parkville]], [[Victoria (Australia)|Victoria]]. * [[Brazil]]: [[Instituto Butantan]], [[São Paulo]] * [[Costa Rica]]: [[Instituto Clodomiro Picado]], [[San José, Costa Rica|San José]] * USA, The Antivenom Index is a joint project of the [[Association of Zoos and Aquariums]] and the American Association of Poison Control Centers: They maintain a website to help locate rare antivenins.[http://www.aza.org/ai/] * USA, [[Colorado]]: Poisindex central office in [[Denver, Colorado]], USA (1-800-332-3073). * [[USA]], [[Miami, Florida]]: The Miami-Dade Fire Rescue Antivenom Bank: Emergency: 1-786-336-6600 available 24 hours. A list of available antivenins 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] ==Footnotes== {{reflist|2}} ==External links== * [http://www.emedicine.com/med/topic2143.htm Snakebite]. eMedicine. * [http://www.newscientist.com/article.ns?id=dn9277&feedId=online-news_rss20 New antivenom could save more snakebite victims] [[Category:Toxicology]] [[Category:Antibodies]] [[de:Antivenin]] [[he:נסיוב]] [[pl:Antytoksyna]] [[uk:Антитоксини]] [[es:antisuero]]