Abstract
To the Editor:
We would like to thank Drs Persson, Stiber, and Warrell for their helpful comments on our case report of severe envenoming by Vipera berus in a 12-year-old child. 1 We agree that the situation at the time of admission fulfilled the reported criteria for antivenom treatment. The boy was not treated with antivenom therapy because nearly all symptoms of envenoming apart from rapidly spreading swelling improved rather quickly under supportive therapy and the risk of antivenom therapy was considered to be higher than the potential benefit.
The question of when to administer antivenom may be clearly answered within the community of snake bite specialists. In clinical medicine, however, some controversy and confusion still remain. Professor Warrell acknowledges that specific antidotes are underused in the United Kingdom. 2 This may be true in continental Europe as well, and we would favor the publication of guidelines addressed specially to the therapy of children in a general medical journal as an amendment to his clinical review in the British Medical Journal published in 2005.