Pitfalls in Elapid Envenomation

The clinical management of elapid envenomation is severely hindered by low molecular mass alpha-neurotoxins (6–7 kDa). As these molecules are notoriously poor immunogens, traditional antivenoms often exhibit low neutralisation potency (<1 mg/mL). In response, Ratanabanangkoon (2021) details the Diverse Toxin Repertoire (DTR) strategy, which enriches immunisation protocols to enhance epitope recognition. This approach successfully established paraspecificity against 27 distinct Asian and African elapid venoms.

Conversely, reliance on phenotypic similarity can be fatal. Madrigal Anaya et al. (2022) analysed a Naja kaouthia envenomation where Micrurus antivenom proved ineffective. Serological evidence confirmed a lack of binding affinity, highlighting that geographical divergence creates insurmountable antigenic gaps despite shared neuromuscular blockade mechanisms. Furthermore, Madrigal Anaya et al. (2022) identified a venom rebound phenomenon, attributed to a functional depot at the bite site. This suggests that the pharmacokinetics of F(ab’)2 fragments require urgent optimisation to counter the delayed release of toxins in exotic envenomations.

Scientific Bibliography

• Madrigal Anaya, J. C., Cruz Ibarra, A., Rodríguez Uvalle, N. C., Alarcón, G. G., Alagón, A., Rodríguez Flores, G., et al. (2022)A case of exotic envenomation by Naja kaouthia in Mexicohttps://doi.org/10.34141/LJCS4666817
• Ratanabanangkoon, K. (2021)A Quest for a Universal Plasma-Derived Antivenom Against All Elapid Neurotoxic Snake Venomshttps://doi.org/10.3389/fimmu.2021.668328