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The genus Vipera encompasses most species of medically significant venomous snakes of Europe, with Italy harbouring four of them. Envenomation by European vipers can result in severe consequences, but underreporting and the absence of standardised clinical protocols hinder effective snakebite management. This study provides an updated, detailed set of guidelines for the management and treatment of Vipera snakebite tailored for Italian clinicians. It includes taxonomic keys for snake identification, insights into viper venom composition, and recommendations for clinical management. Emphasis is placed on quick and reliable identification of medically relevant snake species, along with appropriate first aid measures. Criteria for antivenom administration are outlined, as well as indications on managing potential side effects. While the protocol is specific to Italy, its methodology can potentially be adapted for other European countries, depending on local resources. The promotion of comprehensive data collection and collaboration among Poison Control Centres is advocated to optimise envenomation management protocols and improve the reporting of epidemiological data concerning snakebite at the country level. [ABSTRACT FROM AUTHOR]

ETHICS STATEMENT The patients and patients' parents in this manuscript have given written informed consent to the publication of their case details. Animal bites and stings pose a major public health problem in children and adults worldwide and are set to increase due to climate change and overpopulation.[1] It is curious how the dermatological scientific literature pays only a little attention to this aspect. Regarding the management, after the sting, the patient must reach the shore as soon as possible (cases of fainting in water are frequent),[4] therefore, it is important to clean the affected site, removing any residues of thorns. [Extracted from the article]

Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment. We report the clinical symptoms induced by envenomations and poisoning caused by reptiles, fishes, amphibians and mammals in Europe, ranging from mild, local symptoms (e.g., erythema, edema) to systemic and potentially deadly. The present work constitutes a tool for physicians to recognize envenomation/poisoning symptoms caused by the most medically relevant European vertebrates and to decide which approach is the most appropriate to treat them. [ABSTRACT FROM AUTHOR]

• Snakebite is a neglected disease in Europe. • Children can be affected by snakebites also in Europe. • Children snakebites in Europe shows higher morbidity and mortality compared to adults. [ABSTRACT FROM AUTHOR]