Hypersensitivity reactions due to North American pit viper antivenom administration and confirmed elevation of alpha-gal IgE

Abstract

The two current antivenom products available in the United States (US) for North American pit viper envenomation include ovine-derived Crotalidae polyvalent immune Fab (FabAV, Crofab^®) and equine-derived Crotalidae Immune (F(ab′)2, Anavip^®). Both products contain the oligosaccharide, galactose-alpha-1,3-galactose (alpha-gal), and may lead to a hypersensitivity reaction commonly referred to as alpha-gal syndrome (AGS). We report two patients receiving antivenom for pit viper envenomation who developed anaphylactic reactions and had confirmed abnormal titers of alpha-gal-specific IgE. We suggest clinicians seek a history of red meat allergy and administer AV cautiously in endemic areas of AGS.

Keywords:

• Antivenom
• alpha-gal
• allergy
• case report

Acknowledgments

The authors would like to thank Drs. Bo Burns and Laura Stuemky for their assistance.

Ethical approval

This was considered by the University of Oklahoma Institutional Review Board and did not meet the criteria for human subjects research. This work has not been published prior.

Disclosure statement

Drs. Edelen, Moore, and Epperson have no conflicts of interest to declare. Dr. Banner has been a speaker for BTG manufacturer of Crofab^®.

Data availability statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Additional information

Funding

No grant support was used for this project.