title: Severe adverse drug reaction following Crotalidae Polyvalent Immune Fab (Ovine) administration for copperhead snakebite.
abstract: OBJECTIVE
  To present the case of a severe anaphylactic/anaphylactoid reaction to Crotalidae Polyvalent Immune Fab (Ovine) in a patient bitten by a copperhead snake.
  
  
  METHODS
  A 68-year-old man presented with progressive envenomation after receiving a copperhead snakebite on each hand. Crotalinae Fab antivenom was administered. While the initial and only dose was partially infusing, the patient developed an adverse drug reaction (ADR) of urticaria and hypotension, which resolved with cessation of the infusion, recurred with resumption of the infusion, and ultimately was completed with supportive care. An additional episode of hypotension, urticaria, and angioedema occurred shortly after antivenom therapy completion. Epinephrine was administered, resolving the reaction with complete patient recovery. The event received a Naranjo score of 10, indicating a definite ADR.
  
  
  CONCLUSIONS
  Treating copperhead snakebites with antivenom is a matter of debate. Concern over adverse events and cost induce some physicians to manage copperhead bites without antivenom because they are generally milder in severity.
  
  
  CONCLUSIONS
  As demonstrated in this case, severe ADR can occur with Crotalinae Fab antivenom, and its efficacy for copperhead envenoming needs to be better established via placebo-controlled, randomized trials.
authors.affiliation: Vidant Medical Center, Greenville, NC, USA.
authors.forename: Maryjoy R
authors.initials: MR
authors.lastname: Lepak
authors.affiliation: University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
authors.forename: Samantha H
authors.initials: SH
authors.lastname: Bochenek
authors.affiliation: Vidant Medical Center, Greenville, NC, USA East Carolina University Brody School of Medicine, Greenville, NC, USA seanbushmd@gmail.com.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Bush
mesh_terms: D000368:Aged; D017836:Agkistrodon; D000799:Angioedema / Q000209:etiology; D000818:Animals; D000997:Antivenins / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects*; D008297:Male; D012008:Recurrence; D012756:Sheep; D012909:Snake Bites / Q000628:therapy*; D014581:Urticaria / Q000209:etiology
chemical_list: D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments
keywords: CroFab; Crotalidae polyvalent immune Fab; adverse drug reaction; anaphylactic reaction; antivenom; copperhead