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Important CSL Antivenom Information
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by Phobos on April 20, 2009
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An examination of the activity of expired and mistreated commercial Australian antivenoms
Margaret A. O’Learya, Rachelle S. Kornhauserb, Wayne C. Hodgsonb and Geoffrey K. Isbister
aDepartment of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle Hospital, Newcastle, New South Wales, Australia
bMonash Venom Group, Department of Pharmacology, Monash University, Victoria, Australia
cTropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Received 17 September 2008; revised 14 November 2008; accepted 14 November 2008. Available online 13 January 2009.
Summary
Expired antivenoms may be useful in countries where snake envenoming is common and supplies are limited. This study examined the activity of expired Australasian antivenoms. Expired CSL snake antivenoms, including taipan, brown snake and polyvalent antivenoms, were used. The most current antivenom was used as the reference to compare expired antivenoms. Binding activity was assessed by enzyme immunoassay. Neutralisation of venom clotting effects was assessed by a modified clotting test using changes in optical density. Neutralisation of the in vitro neurotoxic effects of taipan venom was determined using a chick biventer cervicis nerve–muscle preparation. All antivenom batches remained active, with gradual deterioration in activity and binding over time. All batches of taipan antivenom at concentrations equivalent to the administration of one vial (including one 15 years expired) prevented clotting by taipan venom. Brown snake antivenoms also prevented clotting, except two that were 10 years old. All expired taipan/polyvalent antivenom prevented in vitro neurotoxicity at concentrations consistent with antivenom treatment. Freeze–thawing the antivenom or leaving it at room temperature for 3 days caused only small decreases in activity. CSL antivenoms are more robust than indicated on their label and maintain useful activity long past their nominated expiry dates.
Keywords: Antivenom; Neurotoxicity; Coagulopathy; Antibodies; Snake; Snake bite
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RE: Important CSL Antivenom Information
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by puffadder7 on April 20, 2009
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wonderful, lets give expired A/V for the most toxic snakes in the world, not too good, arin
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RE: Important CSL Antivenom Information
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by Cro on April 20, 2009
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Those expired Antivenoms could be shipped to third world countries and used to help save snake bitten folks.
Those countries do not have the strict FDA restrictions that we do.
Dr. David Williams in Papua New Guinea comes to mind as a possible person to ship to. Also, other expired Antivenoms could be shipped to India and Sri Lanka, and to parts of Central and South America where snake bites are common, and medical help is lacking.
When I worked at the Atlanta Zoo, we saved expired Antivenom, as we knew it could serve as an emergency backup to the small supply of fresh Antivenom that we had in stock.
Perhaps the Zoos and Venom 1 can get together and set up some kind of expired AV bank that could send it to folks who need it in other countries.
Best Regards
John Z
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RE: Important CSL Antivenom Information
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by AquaHerp on April 20, 2009
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There are of pros and many cons to utilizing outdated serum. Minton showed many years ago that it can still be viable after decades. however, that is not for all the antivenoms, even those of the same type.
It's a hot debate and one that I personally think will err on the side of caution regardless of the efficacy. In real extreme cases it may be used, but I would see the patient having to sign off on it first.
DH
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RE: Important CSL Antivenom Information
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by Phobos on April 21, 2009
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Wow, talk about missing the point Arin! The whole idea is in an emergency, like if you were tagged by the Taipan or Common Brown you keep, expired A/V could be used to keep YOU from being expired too. At nearly $2000usd/vial and it's general unavailability makes outdated A/V look mighty attractive till you have some fresh arrive from somewhere.
Al
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RE: Important CSL Antivenom Information
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by Crotalusssp on April 21, 2009
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The fact that Australian AV is made only in one lab and has such a high costs keeps me from keeping Australian Elapids. I have heard from others keeping, that they maintain out of date vials on hand. If they maintain most of their potential to block enzymatic action, then finding a way to create a list of locations/numbers stock pile, would be a useful way for keepers to help one another/their selves out in the event of an accident. This list could of course be made world wide so that less developed nations such as Sri Lanka, PNG, etc, as John suggested could participate.
Charles
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RE: Important CSL Antivenom Information
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by BGF on April 21, 2009
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Actually the main point of this paper was that none of the CSL monovalents are monovalents. All contain other antigens. In variable amounts. Which I found out after we did a whole bunch of cross-reactivity studies and the batch-to-batch variance really calls a lot of the results into question.
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RE: Important CSL Antivenom Information
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by Crotalusssp on April 21, 2009
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With the cost of the CSL so high, it is disturbing to think that there is that much variability from vial to vial. Do you have any hypothesis as to the cause of the variances Dr. Fry?
Charles B.
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RE: Important CSL Antivenom Information
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by Cro on April 21, 2009
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Does anyone know if the entire study is available somewhere online, at a site that does not want to charge $31.00 for it ?
I would sure like to read the entire paper.
Best Regards
John Z
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