Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (11)

Fab Antivenom Found To Cause Fewer Allergic Reactions Than Previously Thought

Crofab AntivenomThe current standard of care with regard to using antivenom for pit viper snakes (e.g., rattlesnakes, copperheads, cottonmouths) in North America is to use Crotalidae polyvalent immune Fab antivenom (CroFab;FabAV). This antivenom is created using a process that obtains antibodies “raised” by immunizing sheep and then harvesting and purifying the product. One of the major benefits of using this product is to take advantage of a lesser incidence of allergic reactions (than have traditionally been observed with previous products). It appears that the situation regarding the incidence of allergic reactions may be better than previously thought.

In the article, “Short Term Outcomes After Fab Antivenom Therapy for Severe Crotaline Snakebite,” Eric Lavonas, MD and colleagues (Ann Emerg Med 2011;57:128-137) examined the short-term outcomes associated with the use of Crotalidae polyvalent immune Fab therapy and, in particular, the incidence of hypersensitivity (allergic) reactions associated with FabAV use. The primary outcome for response to therapy was the change in overall envenomation severity after FabAV administration, as well as the rates of immediate hypersensitivity reactions and serum sickness (a slightly delayed, different type of allergic reaction).

All severely envenomed patients improved after receiving FabAV. Immediate allergic reactions were reported in 6.1 percent of antivenom recipients, and serum sickness reported in five percent. The authors concluded that FabAV therapy is associated with clinical improvement in severe crotaline snake envenomation, and that immediate hypersensitivity and serum sickness rates may be less than half that described in the FabAV prescribing information. This is good news for snakebite patients and for the clinicians who treat them.

This post, Fab Antivenom Found To Cause Fewer Allergic Reactions Than Previously Thought, was originally published on by Paul Auerbach, M.D..

You may also like these posts

Read comments »

11 Responses to “Fab Antivenom Found To Cause Fewer Allergic Reactions Than Previously Thought”

  1. payday loans says:

    You are so interesting! I don’t believe I’ve truly read a single thing like that before. So good to find someone with unique thoughts on this subject. Seriously.. thank you for starting this up. This web site is one thing that’s needed on the web, someone with a little originality! instant payday loans

  2. Great site you have got here.. It’s hard to find high-quality writing like yours nowadays.

    I really appreciate people like you! Take care!! raspberry ketone and
    high blood pressure

  3. The applicant in many cases can overcome their short term financial traps and bridge some small cash space between two involved with their paydays.

    Bad credit borrowers may possibly also avail ones desired loans quantities by requesting to
    a bad borrowing instant loan. quick payday loans

  4. Inside fact even these who have each bad credit historical can avail usually the benefits of these pay
    day loans.
    Used jewelry shop Loans in addition to the payday loans could well be a perfect alternative loan root cause for the distinct looking for rapidly cash.
    payday loans uk

  5. With this type of funding the seller supplies financing
    from the however, if we are running a tight deliver, we will pull through loans
    for people on benefits same day May possibly you do
    not have a direct deposit; you’ll want to education house owners, the best right move is to find a co-signer

  6. Lincoln says:

    Wow that was strange. I just wrote an extremely long comment but after I clicked submit my comment didn’t appear. Grrrr… well I’m not
    writing all that over again. Anyway, just wanted to say wonderful blog!

  7. payday loan says:

    The next option to consider ‘s what is called a high risk loan payday loan But now 12 month payday loans have already been formulated with regard to salary type of people to offer instant cash plus small amount of dollars for the lengthier repayment period

  8. This example testament grow because we are finally getting to the stage where
    some animation, and if you find one that does be wary of them and get a moment popular opinion.

    laser eye surgery cost Every breather U Take is an entrancing amusing motion picture from
    Ace movie theater beneath the route than uploading the substance themselves,
    and provides a Disavowal stating as lots, Technically, they aren’t break any Laws.

  9. The bill was sold to Congress as a way to promote jobs note the acronym on the supposition that
    small start-ups create huge numbers of them. fruitautomaten
    The display went into storage after Stupak replaced the place
    with the tallest structure on the Las Vegas Strip, the 1,149-foot Stratosphere tower resembling the iconic
    Space Needle in Seattle.

  10. e cigarettes says:

    Have got you e’er wondered why you electronic cigarettes are providing a marvelous public Health benefit to those who are Exploitation them. electronic cigarette uk But what makes one e cig dissimilar outset clip in Mainland China in 2005-2007, then lento made their way into the United States.

  11. e-cig says:

    Still, an ASA spokesman said: ‘We renowned the evidence Nicolites submitted, which took the shape of Literature reviews get are Second and white, Addition a new Chrome edition. electronic cigarettes UK You’re nerve-wracking to get rid of the and and then go on to asolution with
    a get down stage like 10 14 mg/ml or 6 8 mg/ml.

Return to article »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »