title: Risk of immediate effects from F(ab)2 bivalent antivenin in Taiwan.
abstract: OBJECTIVE
  To evaluate the incidence of immediate adverse effects from equine fragment antigen binding F(ab)2 bivalent antivenin produced by the National Institute of Preventive Medicine (NIPM) in Taiwan.
  
  
  METHODS
  A retrospective chart review of patients presenting to a 600-bed general hospital over a 3-year period with snakebite who were treated with NIPM antivenin.
  
  
  RESULTS
  A total of 130 snakebite victims presented to the emergency department over the study period, and 159 vials of antivenin were given. One hundred two patients (78.5%; 95% CI: 70, 85) received only hemorrhagic bivalent antivenin, 2 (1.5%; 95% CI: 0, 5) received only neurotoxic bivalent antivenin, and the remaining 26 (20.0%; 95% CI: 13, 28) received both kinds of bivalent antivenin. Three received a second vial of hemorrhagic antivenin because of progression of symptoms. Forty-two patients (32.3%; 95% CI: 24, 41) had positive skin tests, but following pretreatment with diphenhydramine and hydrocortisone, only 1 patient developed a skin rash thought to be related to antivenin. No patient developed an anaphylactic reaction.
  
  
  CONCLUSIONS
  The use of NIPM F(ab)2 antivenin in snakebite victims in Taiwan has a very low risk of acute adverse reactions.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Kweishan Hsiang, Taoyuan Hsien, Taiwan, ROC. a9999999@ms3.hinet.net
authors.forename: J C
authors.initials: JC
authors.lastname: Chen
authors.forename: M J
authors.initials: MJ
authors.lastname: Bullard
authors.forename: T F
authors.initials: TF
authors.lastname: Chiu
authors.forename: C J
authors.initials: CJ
authors.lastname: Ng
authors.forename: S J
authors.initials: SJ
authors.lastname: Liaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012882:Skin Tests; D012909:Snake Bites / Q000628:therapy*; D012910:Snake Venoms; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000997:Antivenins; D007140:Immunoglobulin Fab Fragments; D012910:Snake Venoms