Skip to main content
SpringerLink
Log in

Crotalidae Polyvalent Immune Fab

In Patients with North American Crotaline Envenomation

  • Adis Drug Profile
  • Published:
BioDrugs Aims and scope Submit manuscript

Abstract

Crotalidae polyvalent immune Fab is an antivenom comprising purified, sheep-derived, Fab IgG fragments and is indicated for use in patients with North American crotaline envenomation. Crotalidae polyvalent immune Fab is produced using four North American snake venoms: Crotalus atrox, Crotalus adamanteus, Crotalus scutulatus, and Agkistrodon piscivorus.

Intravenous crotalidae polyvalent immune Fab was effective in patients aged ≥10 years who had minimal or moderate envenomation by a North American crotaline, who presented within 6 hours of the snakebite, and who had progression of the envenomation syndrome, according to the results of two prospective trials. One trial was a noncomparative, multicenter pilot study and the other trial was a randomized, open-label, multicenter trial in which patients received scheduled or ‘as needed’ administration of crotalidae polyvalent immune Fab after initial control had been achieved.

A prospective, postmarketing trial demonstrated the efficacy of crotalidae polyvalent immune Fab in confirmed Crotalus viridis helleri envenomation (indicating cross-protection against a venom not used in its production).

Results of these prospective trials are supported by the findings of additional (mainly retrospective) studies demonstrating the efficacy of crotalidae polyvalent immune Fab in patients with crotaline envenomation, including patients with severe envenomation, pediatric patients, and patients with symptoms of neurotoxicity.

Despite treatment with crotalidae polyvalent immune Fab, patients may experience delayed-onset or recurrent venom effects (e.g. coagulopathy).

Intravenous crotalidae polyvalent immune Fab was generally well tolerated; acute hypersensitivity reactions (e.g. urticaria, rash, pruritus) were the most commonly occurring adverse event.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1

Similar content being viewed by others

References

  1. Gold BS, Barish RA, Dart RC. North American snake envenomation: diagnosis, treatment, and management. Emerg Med Clin North Am 2004; 22(2): 423–43

    Article  PubMed  Google Scholar 

  2. Dart RC, Hurlbut KM, Garcia R, et al. Validation of a severity score for the assessment of crotalid snakebite. Ann Emerg Med 1996 Mar; 27(3): 321–6

    Article  PubMed  CAS  Google Scholar 

  3. Boyer LV, Seifert SA, Cain JS. Recurrence phenomena after immunoglobulin therapy for snake envenomations: part 2. Guidelines for clinical management with crotaline Fab antivenom. Ann Emerg Med 2001 Feb; 37(2): 196–201

    Article  PubMed  CAS  Google Scholar 

  4. Seger D, Kahn S, Krenzelok EP. Treatment of US crotalidae bites: comparisons of serum and globulin-based polyvalent and antigen-binding fragment antivenins. Toxicol Rev 2005; 24(4): 217–27

    Article  PubMed  CAS  Google Scholar 

  5. Schmidt JM. Antivenom therapy for snakebites in children: is there evidence? Curr Opin Pediatr 2005 Apr; 17(2): 234–8

    Article  PubMed  Google Scholar 

  6. Dart RC, Seifert SA, Boyer LV, et al. A randomized multicenter trial of crotalinae polyvalent immune Fab (ovine) antivenom for the treatment for crotaline snakebite in the United States. Arch Intern Med 2001 Sep 10; 161(16): 2030–6

    Article  PubMed  CAS  Google Scholar 

  7. Corneille MG, Larson S, Stewart RM, et al. A large single-center experience with treatment of patients with crotalid envenomations: outcomes with and evolution of antivenin therapy. Am J Surg 2006 Dec; 192(6): 848–52

    Article  PubMed  Google Scholar 

  8. Goto CS, Feng S-Y. Crotalidae polyvalent immune Fab for the treatment of pediatric crotaline envenomation. Pediatr Emerg Care 2009 Apr; 25(4): 273–9

    Article  PubMed  Google Scholar 

  9. BTG International Inc. CroFab® (crotalidae polyvalent immune Fab [ovine]): US prescribing information [online]. Available from URL: http://www.crofab.com/pdf/CroFab_PI.pdf [Accessed 2010 Dec 6]

  10. Dart RC, Borron SW, Caravati EM, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med 2009 Sep; 54(3): 386–94

    Article  PubMed  Google Scholar 

  11. Dart RC, Seifert SA, Carroll L, et al. Affinity-purified, mixed monospecific crotalid antivenom ovine Fab for the treatment of crotalid venom poisoning. Ann Emerg Med 1997 Jul; 30(1): 33–9

    Article  PubMed  CAS  Google Scholar 

  12. Chippaux J-P, Goyffon M. Venoms, antivenoms and immunotherapy. Toxicon 1998 Jun; 36(6): 823–46

    Article  PubMed  CAS  Google Scholar 

  13. Seifert SA, Boyer LV. Recurrence phenomena after immunoglobulin therapy for snake envenomations: part 1. Pharmacokinetics and pharmacodynamics of immunoglobulin antivenoms and related antibodies. Ann Emerg Med 2001 Feb; 37(2): 189–95

    Article  PubMed  CAS  Google Scholar 

  14. Dart RC, McNally J. Efficacy, safety, and use of snake antivenoms in the United States. Ann Emerg Med 2001 Feb; 37(2): 181–8

    Article  PubMed  CAS  Google Scholar 

  15. Offerman SR, Barry JD, Schneir A, et al. Biphasic rattlesnake venom-induced thrombocytopenia. J Emerg Med 2003 Apr; 24(3): 289–93

    Article  PubMed  Google Scholar 

  16. Schmaier AH, Claypool W, Colman RW. Crotalocytin: recognition and purification of a timber rattlesnake platelet aggregating protein. Blood 1980 Dec; 56(6): 1013–9

    PubMed  CAS  Google Scholar 

  17. Schmaier AH, Colman RW. Crotalocytin: characterization of the timber rattlesnake platelet activating protein. Blood 1980 Dec; 56(6): 1020–8

    PubMed  CAS  Google Scholar 

  18. Consroe P, Egen NB, Russell FE, et al. Comparison of a new ovine antigen binding fragment (Fab) antivenin for United States crotalidae with the commercial antivenin for protection against venom-induced lethality in mice. Am J Trop Med Hyg 1995 Nov; 53(5): 507–10

    PubMed  CAS  Google Scholar 

  19. Bush SP, Green SM, Moynihan JA, et al. Crotalidae polyvalent immune Fab (ovine) antivenom is efficacious for envenomations by Southern Pacific rattlesnakes (Crotalus helleri). Ann Emerg Med 2002 Dec; 40(6): 619–24

    Article  PubMed  Google Scholar 

  20. Lavonas EJ, Kokko J, Schaeffer TH, et al. Short-term outcomes after Fab antivenom therapy for severe crotaline snakebite. Ann Emerg Med 2011 Feb; 57(2): 128–37.e3

    Article  PubMed  Google Scholar 

  21. Offerman SR, Bush SP, Moynihan JA, et al. Crotaline Fab antivenom for the treatment of children with rattlesnake envenomation. Pediatrics 2002 Nov; 110(5): 968–71

    Article  PubMed  Google Scholar 

  22. Pizon AF, Riley BD, LoVecchio F, et al. Safety and efficacy of crotalidae polyvalent immune Fab in pediatric crotaline envenomations. Acad Emerg Med 2007 Apr; 14(4): 373–6

    Article  PubMed  Google Scholar 

  23. Clark RF, Williams SR, Nordt SP, et al. Successful treatment of crotalidinduced neurotoxicity with a new polyspecific crotalid Fab antivenom. Ann Emerg Med 1997 Jul; 30(1): 54–7

    Article  PubMed  CAS  Google Scholar 

  24. Ruha A-M, Curry SC, Beuhler M, et al. Initial postmarketing experience with crotalidae polyvalent immune Fab for treatment of rattlesnake envenomation. Ann Emerg Med 2002 Jun; 39(6): 609–15

    Article  PubMed  Google Scholar 

  25. Ruha A-M, Curry SC, Albrecht C, et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon 2011 Jan; 57(1): 53–9

    Article  PubMed  CAS  Google Scholar 

  26. Lavonas EJ, Gerardo CJ, O’Malley G, et al. Initial experience with crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med 2004 Feb; 43(2): 200–6

    Article  PubMed  Google Scholar 

  27. Cannon R, Ruha A-M, Kashani J. Acute hypersensitivity reactions associated with administration of crotalidae polyvalent immune Fab antivenom. Ann Emerg Med 2008 Apr; 51(4): 407–11

    Article  PubMed  Google Scholar 

  28. O’Brien NF, DeMott MC, Suchard JR, et al. Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation. Pediatr Emerg Care 2009 Jul; 25(7): 457–9

    Article  PubMed  Google Scholar 

Download references

Acknowledgments and Disclosures

The manuscript was reviewed by: R.C. Dart, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA; A.-M. Ruha, Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA.

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was also offered an opportunity to comment on this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

Author information

Authors and Affiliations

  1. Adis, a Wolters Kluwer Business, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand

    Gillian M. Keating

Authors
  1. Gillian M. Keating
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gillian M. Keating.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keating, G.M. Crotalidae Polyvalent Immune Fab. BioDrugs 25, 69–76 (2011). https://doi.org/10.2165/11207250-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11207250-000000000-00000

Keywords

Search

Navigation