Intervenções clínicas aos efeitos adversos dos antivenenos: Revisão de escopo

Abstract

Mapping clinical interventions to the adverse effects of antivenoms, as well as the characteristics of these antivenoms that favor the occurrence of such events.

Method: Scoping review. Articles in English and Portuguese were included, with no time limit, that answered the following research question: What clinical interventions have been used in the prevention and control of adverse effects to antivenoms and what are the characteristics of these antivenoms that have favored these events? Database selection: Embase (Elsevier), Web of Science (Clarivate), Scopus (Elsevier), and Cochrane Library. Duplicated articles, studies involving animals, and studies incompatible with the proposed research question were excluded. Results: Of the 210 articles identified, 11 were selected. The main strategies for preventing adverse events of antivenoms consist of the administration of antihistamines, corticosteroids, and adrenaline. The efficacy of antihistamines as well as hydrocortisone used alone did not demonstrate effectiveness in preventing the incidence of adverse effects after the administration of antivenoms, even 2 to 4 hours before therapy. In the context of serum sickness, corticosteroids are presented as the indicated therapy. Adrenaline remains the drug of choice in the management of adverse effects, especially anaphylactic shock. Antivenoms with whole immunoglobulin, larger amounts of heterologous proteins, and administration of high doses confer a higher risk of adverse events. Conclusion: The use of antihistamines and corticosteroids alone is not effective in preventing side effects caused by antivenoms. However, adrenaline remains the alternative when anaphylactic shock is an outcome. However, careful evaluation is necessary in the prolonged use of this drug when there is recurrence of anaphylaxis and this has a biphasic course. Antivenoms that have a low degree of purification of heterologous proteins and immunoglobulins require the administration of larger quantities and, therefore, expose the victim to a high risk of adverse reactions.