What is the efficacy of antivenom in the treatment of scorpion envenomation?

Updated: Nov 09, 2018
  • Author: David Cheng, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

A total of 22 types of scorpion antivenom are listed in the American Zoo and Aquarium Association Antivenom Index. They are available for a number of different species and have varied efficacy. Antivenom use remains controversial. Many researchers report decreased morbidity, mortality, and hospital stay with its use. These researchers and clinicians believe that antivenom therapy cannot be matched by supportive care in severe Buthidae scorpion envenomation. Others suggest that adverse effects (eg, anaphylactic reactions, serum sickness) limit or contraindicate antivenom use.

Scorpion toxins are not good antigens because of small size and poor immunogenicity. They do not induce antibodies that cross-react against toxins of other scorpion species unless a 95% amino acid sequence homology exists between the 2 toxins. Thus, no universal antivenin is available.

Furthermore, the neurotoxin component of the scorpion venom tends to be the least immunogenic, resulting in the low efficiency for neurological complications. It usually is prepared from horses because they yield larger quantities. Sheep, goat, or bovine antivenins have been prepared if patient sensitivity to horse serum occurs.

One idea was to mix a batch of different scorpion antivenin together to create a universal antivenin, but this exposes the patient to unnecessary antivenin from scorpion species not from the patient's region.


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