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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Amphib. Reptile Sci.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Amphibian and Reptile Science</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Amphib. Reptile Sci.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">2813-6780</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/famrs.2026.1754226</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Brief Research Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>34 reports of snakebite envenoming by the Western Hognose snake (<italic>Heterodon nasicus</italic>): a retrospective online survey</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Damm</surname><given-names>Maik</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>*</sup></xref>
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<name><surname>Vilcinskas</surname><given-names>Andreas</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
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<contrib contrib-type="author">
<name><surname>Kreuels</surname><given-names>Benno</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
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<name><surname>L&#xfc;ddecke</surname><given-names>Tim</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
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<aff id="aff1"><label>1</label><institution>Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology IME</institution>, <city>Giessen</city>,&#xa0;<country country="de">Germany</country></aff>
<aff id="aff2"><label>2</label><institution>Institute of Insect Biotechnology, Justus-Liebig-University Giessen</institution>, <city>Giessen</city>,&#xa0;<country country="de">Germany</country></aff>
<aff id="aff3"><label>3</label><institution>Landes-Offensive zur Entwicklung Wissenschaftlich-&#xf6;konomischer Exzellenz (LOEWE) Centre for Translational Biodiversity Genomics (LOEWE-TBG)</institution>, <city>Frankfurt am Main</city>,&#xa0;<country country="de">Germany</country></aff>
<aff id="aff4"><label>4</label><institution>Branch Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology IME</institution>, <city>Giessen</city>,&#xa0;<country country="de">Germany</country></aff>
<aff id="aff5"><label>5</label><institution>Department of Medicine, Division of Tropical Medicine, University Medical Center Hamburg-Eppendorf</institution>, <city>Hamburg</city>,&#xa0;<country country="de">Germany</country></aff>
<aff id="aff6"><label>6</label><institution>Research Group Neglected Diseases and Envenoming, Bernhard-Nocht-Institute for Tropical Medicine</institution>,&#xa0;<city>Hamburg</city>, <country country="de">Germany</country></aff>
<author-notes>
<corresp id="c001"><label>*</label>Correspondence: Maik Damm, <email xlink:href="mailto:maik.damm@agrar.uni-giessen.de">maik.damm@agrar.uni-giessen.de</email>; Tim L&#xfc;ddecke, <email xlink:href="mailto:tim.lueddecke@ime.fraunhofer.de">tim.lueddecke@ime.fraunhofer.de</email></corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-03-02">
<day>02</day>
<month>03</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2026</year>
</pub-date>
<volume>4</volume>
<elocation-id>1754226</elocation-id>
<history>
<date date-type="received">
<day>25</day>
<month>11</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>31</day>
<month>01</month>
<year>2026</year>
</date>
<date date-type="rev-recd">
<day>29</day>
<month>01</month>
<year>2026</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2026 Damm, Vilcinskas, Kreuels and L&#xfc;ddecke.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Damm, Vilcinskas, Kreuels and L&#xfc;ddecke</copyright-holder>
<license>
<ali:license_ref start_date="2026-03-02">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<p>The Western Hognose snake, <italic>Heterodon nasicus</italic>, is earth&#x2019;s most commonly kept venomous pet snake. Generally assumed to be harmless, recent reports suggested a more potent venom than originally thought, but literature is scarce. Here, we analyze the severity of bites among keepers of this species via a retrospective online survey. In 34 reports, symptoms were mentioned. They range from local pain for short time frames to extensive edema that resolve after several days or weeks. Severity was correlated with exposure time to the bite. While symptom resolution time can be long in intense cases, no sequelae or fatalities occur and envenoming can be prevented by simple security measures, such as using gloves. Therefore, we evaluate the venom of <italic>H. nasicus</italic> to be indeed more damaging than hitherto assumed, yet the species appears to pose no severe danger to humans and we do not see the necessity to impose legal constraints on its role within the pet trade and husbandry.</p>
</abstract>
<kwd-group>
<kwd>animal handling</kwd>
<kwd>community-based</kwd>
<kwd>non-front fanged snakes</kwd>
<kwd>pets</kwd>
<kwd>rear-fanged</kwd>
<kwd>reptiles</kwd>
<kwd>venoms</kwd>
<kwd>zootoxinology</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was received for this work and/or its publication. M. Damm and T. L&#xfc;ddecke are funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation), refs. 540833593 (MD) and 505696476 (TL). This work was also financially supported by the LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG) granted to A. Vilcinskas via the Landesoffensive zur F&#xf6;rderung der Wissenschaftlich-&#xd6;konomischen Exzellenz (LOEWE) of the Hessian Ministry of Higher Education, Research and the Arts (HMWK).</funding-statement>
</funding-group>
<counts>
<fig-count count="2"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="24"/>
<page-count count="8"/>
<word-count count="3432"/>
</counts>
<custom-meta-group>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Behavior and Ecology</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>Snakes are globally important components of the international pet trade and enthusiastically kept in many households. One of the most commonly encountered snake species is the Western Hognose snake, <italic>Heterodon nasicus</italic>. This small-bodied colubrid naturally occurs in Canada, the United States, and Mexico, where it inhabits several dry habitats and exhibits a semi-fossorial lifestyle (<xref ref-type="bibr" rid="B2">Averill-Murray, 2009</xref>). Because of its attractive phenotype and easy husbandry requirements, this species has manifested as a staple in the herpetocultural community and is frequently bred (<xref ref-type="bibr" rid="B17">Stallins and Kelley, 2013</xref>). In countries such as Germany, the United Kingdom, or the United States, it is under the top 10 pet snake species, only surpassed by various boas and pythons as well as the corn snake (<italic>Pantherophis guttatus</italic>) (<xref ref-type="bibr" rid="B7">Krautwald-Junghanns, 2018</xref>; <xref ref-type="bibr" rid="B1">Animal Welfare Committee, 2023</xref>; <xref ref-type="bibr" rid="B14">Personal communication with international breeders and keepers, 2025</xref>).</p>
<p>Interestingly, <italic>H. nasicus</italic> also carries a functional venom system, commonly unknown or neglected (<xref ref-type="bibr" rid="B21">Weinstein et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B8">Kroll, 1976</xref>). This makes <italic>H. nasicus</italic> by definition earth&#x2019;s most commonly kept venomous pet snake, even so neither highly dangerous nor deadly. As a non-front fanged snake (NFFS), it harbors enlarged, ungrooved fangs connected to a venom-producing gland in the anterior part of its upper jaw, referred to as the Duvernoy&#x2019;s gland (<xref ref-type="bibr" rid="B19">Taub, 1967</xref>). As for most snake venoms, its function is assumed to be for prey subjugation and appears to be relatively simple (<xref ref-type="bibr" rid="B4">Brandehoff et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B6">Hill and Mackessy, 2000</xref>). A detailed venomics analysis of its composition remains missing thus far. First impressions on molecular weights suggest venom components such as CRISP (cysteine-rich secretory protein), svMP (snake venom metalloproteinase), and phosphodiesterase, comparable to other NFFS venom compositions (<xref ref-type="bibr" rid="B4">Brandehoff et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B12">Modahl and Mackessy, 2019</xref>).</p>
<p>Traditionally, <italic>H. nasicus</italic> has been considered non-venomous and fully harmless to humans. However, this outdated view still persists in the community. One reason might be the low amount of available literature, which are not always freely available. For example, PubMed as an important, openly accessible database lists only 18 references, of which less than half are about bites or venom of <italic>H. nasicus</italic>. Less than 15 sporadic reports across the last century (<xref ref-type="bibr" rid="B3">Bragg, 1960</xref>; <xref ref-type="bibr" rid="B13">Morris, 1985</xref>; <xref ref-type="bibr" rid="B21">Weinstein et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B23">Zieli&#x144;ski, 2021</xref>) as well as two reported cases of more severe envenomation have been published (<xref ref-type="bibr" rid="B4">Brandehoff et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B20">Weinstein and Keyler, 2009</xref>) raising the question as to whether the initial assessment of this snake&#x2019;s potential to cause harm needs to be reevaluated. This topic remains largely unexplored despite its relevance given the frequency with which this snake is kept privately around the globe and the low number of case or experience reports.</p>
<p>Therefore, we leverage the global community of herpetoculturalists keeping this species and implement them as a target group for a specifically designed online questionnaire. Through this, we strategically identify the prevalence and symptomatic spectrum of <italic>H. nasicus</italic> bites alongside key data on the respective victim, the snake, and the bite context. We report the details and image documentations of four cases in which photos were provided. Thereby, our first assessment serves as an important addition to the otherwise sparse literature on the bites of <italic>H. nasicus</italic> and extend it by 34 symptomatically positive reports.</p>
</sec>
<sec id="s2">
<label>2</label>
<title>Methods</title>
<sec id="s2_1">
<label>2.1</label>
<title>Survey execution</title>
<p>A retrospective online survey of 23 questions was designed and distributed in three languages (English, German, and Spanish) via LimeSurvey (<ext-link ext-link-type="uri" xlink:href="https://www.limesurvey.org/">https://www.limesurvey.org/</ext-link>). Additional language selection based on the large herpetocultural community in Germany and the natural distribution of <italic>H. nasicus</italic> also in Mexico was carried out to increase the potential response rate. Thematic topics were (i) introductory question and personal information, (ii) questions about the snake and the bitten person, and (iii) questions about the details and nuances of the bite incident. It has been shared via personal contacts and social media, such as X/Twitter, Bluesky, Facebook, and <italic>Heterodon</italic>-related groups. It was available for 5 weeks, from 31 March 2025 until 2 May 2025. The question catalog and all survey info textboxes are in <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table S1</bold></xref>. Answers were anonymously collected and evaluated. As participants were directly asked for the biological sex and not their gender identity, the evaluation will refer to the sex. Declaration of consent to participate in the study was mandatory to start the survey.</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Survey evaluation</title>
<p>Once the survey ended (3 May 2025), answers were manually sorted, cleaned, and evaluated. Exclusion criteria were as follows: (1) not finished, (2) not meant seriously, (3) not <italic>Heterodon</italic>-related, and (4) multiple submitted/identical answers.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<label>3</label>
<title>Results</title>
<sec id="s3_1">
<label>3.1</label>
<title>General evaluation</title>
<p>We conducted a retrospective online survey on snakebites caused by the Western Hognose snake, <italic>H. nasicus</italic>. Of the 91 submitted replies to the questionnaire, 63 have been rated as evaluable. The surveyed bites occurred across a 31-year period (1994 until 2025; median: 2023, mode: 2024), and 62/63 answers were self-reports. In 34 reports, at least one symptom was mentioned post-bite. Atypically for snakebite, women were overrepresented in our analysis with 25 male versus 34 female participants, with 4 not specifying their sex (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1A</bold></xref>). The victim&#x2019;s age ranged from 11 to 65 years with a median of 29 years and a mean of 31.2 years (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1B</bold></xref>). All 63 incidents occurred with captive pet snakes of both sex (25 males, 29 females, and 7 unknown) and different ages from hatchlings to a 10-year-old individuum (<xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1C, D</bold></xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>General evaluation of reported <italic>Heterodon nasicus</italic> bites and metrics of bite type and symptom resolution. Distribution of victim and snake information by <bold>(A)</bold> biological sex and <bold>(B)</bold> age of the bitten person and <bold>(C)</bold> sex and <bold>(D)</bold> age of the bite responsible <italic>H nasicus</italic>, with non-reported data (NR). <bold>(E)</bold> Behavior of the snake after the bite (<italic>n</italic> = 63), and <bold>(F)</bold> time of symptom resolution grouped by behavior of the snake. No symptoms (beige) and with symptoms (brown). <italic>Bite-and-release</italic> as strike (light gray), <italic>extended bites</italic> as hold (dark gray) and chew (black).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="famrs-04-1754226-g001.tif">
<alt-text content-type="machine-generated">Grouped bar charts showing snakebite case data: Panel A and C compare cases by sex of victim and snake; Panel B and D by age of victim and snake; Panel E by snake behavior (strike, hold, chew) and symptom presence; Panel F illustrates symptom resolution time by snake behavior. Each chart provides case counts for specified categories.</alt-text>
</graphic></fig>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>Prevalence of symptoms, bite circumstances, and relevance of allergies</title>
<p>The incidents happened either during handling (39 reports) or during feeding (24 reports) the snakes. Three different bite types were reported in our questionnaire: (i) <italic>bite-and-release</italic> (snake bites quickly and goes off immediately; 38 reports), (ii) <italic>extended bites</italic> (snake bites and holds on to bite site for several seconds; 10 reports), and (iii) <italic>chewing</italic> (snake bites, holds on to the bite site and starts to chew; 15 reports) (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1E</bold></xref>). A positive correlation of bite intensity with likelihood of symptom onset was observed. Bite-and-release scenarios remain in 37% (14/38) without effects and resolved within 2 days. Extended bites and chewing led to higher occurrences of symptoms (both 80%) and resolved, on average, after 3 and 6 days, respectively (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1F</bold></xref>).</p>
<p>Most bites occurred when interacting with a hungry snake or while catching and transferring the animal into a feeding container. In 10 reports, direct skin contact with prey items [mouse (6&#xd7;), quail egg (1&#xd7;), toad (unspecified prey sp., 1&#xd7;)] or other animals [chameleon (unspecified sp., 1&#xd7;) and sand boa (<italic>Eryx</italic> sp., 1&#xd7;)] before handling the snakes was reported. In six of these reports (chameleon, 3&#xd7; mice, quail eggs, and the toad), the bites were with symptoms.</p>
<p>The medical history of the victims regarding previous snakebites (41 reports) was equal regarding developing no (21/41) or any symptoms (20/41) after an <italic>H. nasicus</italic> bite (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Table S2</bold></xref>). Similarly, the presence of allergies (13 reports) showed no difference for the likelihood of developing symptoms (6/13).</p>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>The symptomatic spectrum of Western Hognose snake bites</title>
<p>A spectrum of 12 different symptoms was reported from the 34 symptomatic cases (<xref ref-type="table" rid="T1"><bold>Table&#xa0;1</bold></xref>). Directly after the snakebite, local bleeding (18%) and pain or a burning/itching sensation (59%) was reported. The pain was mostly localized and perceived as weak, comparable to a bee sting. However, irritating sensations (35%) were commonly perceived for several hours and often disseminated. Local edema was the most prevalent symptom after <italic>H. nasicus</italic> bites (79%) often in combination with impaired joint movement (21%). Edema developed either immediately (3&#xd7;), quickly (within 2 h, 4&#xd7;), or emerged within 3 h (5&#xd7;).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Reported symptoms and their frequency after 34 Western Hognose snakebite envenoming.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" align="left">Symptom</th>
<th valign="middle" align="left">Further descriptions by victims</th>
<th valign="middle" align="left">Frequency (no. of cases)</th>
<th valign="middle" align="left">Symptom ratio by strike:hold:chew</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="left">Edema</td>
<td valign="middle" align="left">Swelling</td>
<td valign="middle" align="left">79% (27)</td>
<td valign="middle" align="left">10:5:12</td>
</tr>
<tr>
<td valign="middle" align="left">Pain</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">41% (14)</td>
<td valign="middle" align="left">3:5:6</td>
</tr>
<tr>
<td valign="middle" align="left">Pruritis</td>
<td valign="middle" align="left">Itching</td>
<td valign="middle" align="left">32% (11)</td>
<td valign="middle" align="left">5:4:2</td>
</tr>
<tr>
<td valign="middle" align="left">Impaired movement</td>
<td valign="middle" align="left">Stiffness</td>
<td valign="middle" align="left">21% (7)</td>
<td valign="middle" align="left">2:3:2</td>
</tr>
<tr>
<td valign="middle" align="left">Erythema</td>
<td valign="middle" align="left">Red skin, discoloration</td>
<td valign="middle" align="left">18% (6)</td>
<td valign="middle" align="left">2:3:1</td>
</tr>
<tr>
<td valign="middle" align="left">Bleeding</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">18% (6)</td>
<td valign="middle" align="left">3:1:2</td>
</tr>
<tr>
<td valign="middle" align="left">Pain (burning)</td>
<td valign="middle" align="left">Burning sensation</td>
<td valign="middle" align="left">15% (5)</td>
<td valign="middle" align="left">3:0:2</td>
</tr>
<tr>
<td valign="middle" align="left">Paresthesia</td>
<td valign="middle" align="left">Numbness</td>
<td valign="middle" align="left">15% (5)</td>
<td valign="middle" align="left">1:1:3</td>
</tr>
<tr>
<td valign="middle" align="left">Nausea</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">3% (1)</td>
<td valign="middle" align="left">0:1:0</td>
</tr>
<tr>
<td valign="middle" align="left">Weakness</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">3% (1)</td>
<td valign="middle" align="left">0:1:0</td>
</tr>
<tr>
<td valign="middle" align="left">Blistering</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">3% (1)</td>
<td valign="middle" align="left">0:0:1</td>
</tr>
<tr>
<td valign="middle" align="left">Scabbing</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">3% (1)</td>
<td valign="middle" align="left">0:0:1</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>With Bite-and-release as strike and extended bites as hold.</p></fn>
</table-wrap-foot>
</table-wrap>
<p>General bite-related symptoms had an average resolution time of 3 to 4 days, ranging from a few hours (30%) up to 1 week (18%). Long-term sequelae were described in two reports. In report HN06, severe blistering across the whole arm for 3 weeks with following scabbing of the region (over several months) was reported, and in HN04, weakness in the bitten hand for over 1 year was reported.</p>
</sec>
<sec id="s3_4">
<label>3.4</label>
<title>Detailed envenomation reports</title>
<p>Of the 63 reported <italic>H. nasicus</italic> bites, seven patients (11%) went for professional medical help in response to the quickly developing and extensive edema, with four medication cases [antihistamine administration (2&#xd7;), steroid administration (1&#xd7;), and tetanus prophylaxis (1&#xd7;)]. In 11 reports, self-medication was performed with antihistamines (9&#xd7;), analgesics (4&#xd7;), and furosemide (1&#xd7;). In report HN15, the patient was under Claritin treatment prior to the bite but nevertheless developed extensive edema for 48 h. Four of the victims documented the case with pictures and provided detailed reports of the incidents.</p>
<sec id="s3_4_1">
<label>3.4.1</label>
<title>Report HN02</title>
<p>On 2 June 2020, a 26-year-old woman (Cambridge, UK) was bitten by a captive <italic>H. nasicus</italic> (1 year old, female), while the patient was removing the snake from its enclosure. The snake snapped at the right thumb (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2A&#x2013;F</bold></xref>) and started chewing. After a few minutes, the patient managed to get the snake to release the thumb, which showed immediate swelling and pain. Within 1 h, the swelling had spread across the hand and the patient attended the emergency room of a nearby hospital, where an intravenous injection of antihistamines was administered. The swelling resolved within 3 days and no long-term effects were reported. The patient had not been bitten by a snake previously.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Four reports of <italic>Heterodon nasicus</italic> bites. Report <bold>(A&#x2013;F)</bold> HN02 at the right hand of a 26-year-old woman, <bold>(G, H)</bold> HN03 at D2 (left hand) of a 32-year-old woman, <bold>(I&#x2013;N)</bold> HN15 at D1 (left hand) of a 24-year-old woman, <bold>(O, P)</bold> HN17 at interdigital D2/3 (left hand) of a 25-year-old man and the snake.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="famrs-04-1754226-g002.tif">
<alt-text content-type="machine-generated">Panel of photographs shows progression of hand swelling and injury over time after bites by a snake, with each image labeled by time after envenomation. Initial images show the bite event, subsequent images show swelling, redness, and recovery. Panel P shows the snake species Heterodon nasicus in a terrarium.</alt-text>
</graphic></fig>
</sec>
<sec id="s3_4_2">
<label>3.4.2</label>
<title>Report HN03</title>
<p>On 23 May 2023, a 32-year-old woman (Gainesville, FL, USA) was bitten by a captive <italic>H. nasicus</italic> (1 year old, female) into the right index finger (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2G, H</bold></xref>). The patient had previously been bitten by several snakes (not specified) while working as a herpetologist. Previous bites led to no symptoms. The incident happened during feeding, when the snake grabbed the finger and started to chew. Directly after the bite, the finger showed signs of swelling and hyperthermia. The patient self-administered antihistamines and ibuprofen. As the swelling expanded to the hand after 3 h, the patient decided to seek medical care. Blood tests were run (no results submitted) and the swelling, heart rate, and blood pressure were monitored every 20 min for 6.5 h, but the patient did not receive further treatment. The swelling resolved after one and a half day and no long-term effects were reported.</p>
</sec>
<sec id="s3_4_3">
<label>3.4.3</label>
<title>Report HN15</title>
<p>On 30 September 2022, a 24-year-old woman (Miami, FL, USA) was bitten by a captive <italic>H. nasicus</italic> (25 cm, 2+ years old, male) into the left thumb (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2I&#x2013;N</bold></xref>). The patient was previously bitten by numerous pet snakes (<italic>H. nasicus</italic>, Boidae, Pythonidae, and other Colubridae, like <italic>Boiga irregularis</italic> and <italic>Chrysopelea</italic> sp.) during private and professional handling with no resulting symptoms. The incident happened when the snake was removed from its enclosure for cleaning. The <italic>H. nasicus</italic> bit and chewed on the thumb for &#x201c;between 30 seconds and a minute&#x201d;. Directly after the bite, the patient &#x201c;[ &#x2026; ] felt a burning and itching sensation travel up my thumb all the way to my shoulder&#x201d;. The pain increased up to &#x201c;similar to a bee sting&#x201d;. Within a few hours, the whole hand was swollen, turned red, felt &#x201c;like how your arm or leg would feel if it fell asleep&#x201d;, and the thumb was stiff. Five hours post bite, the burning and itching in the arm subsided, but the thumb and the back of the hand &#x201c;felt tight, hot, and painful&#x201d;. After 36 to 48 h, the swelling started to subside, but a feeling of &#x201c;tightness&#x201d; and pain persisted for 1 week. During the time of the incident, the patient was taking the following medication: antihistamines (for allergies), modafinil, omeprazole, sertraline, and a hormonal intrauterine device. No professional medical help was sought. No long-term effects were reported.</p>
</sec>
<sec id="s3_4_4">
<label>3.4.4</label>
<title>Report HN17</title>
<p>In March 2023, a 25-year-old man (Houston, TX, USA) was bitten by a captive <italic>H. nasicus</italic> (20&#x2013;30 cm, unknown age, male) into the left hand (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2O, P</bold></xref>). The patient had previously been bitten by pet snakes (<italic>Nerodia rhombifer</italic> and <italic>Pantherophis</italic> sp.) with no resulting symptoms. The incident happened during a routine handling. The snake rubbed its snout against the hand, as if it were trying to burrow, then it bit between the index and middle finger and started to chew. Directly after the bite, the patient reported &#x201c;stinging pain, followed by a very warm prickly sensation as swelling began&#x201d;. Within the next 2 h, the swelling extended to the hand, and the patient felt that the hand was &#x201c;hot, sore and achy, with particular discomfort in the joints&#x201d;. After several hours, antihistamines were self-administered but had no effect. With cooling, the symptoms began to reside after approximately 36 h, but continued for approximately 4 days. No professional medical help was sought and no long-term effects were reported.</p>
</sec>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<label>4</label>
<title>Discussion</title>
<p>We carried out the first symptom-focused analysis of bite cases of <italic>H. nasicus</italic> via a retrospective community-based online questionnaire distributed among keepers and herpetologists. It&#xa0;should be noted that the retrospective, self-reporting nature of the study limits its scope, particularly since no professional medical reports or data were provided. This also assumes that bites with symptoms are more likely to be reported than &#x201c;unimportant&#x201d; incidents without consequences. Therefore, the actual dry bite (bites without venom administration) rate of <italic>H. nasicus</italic> is much higher than the 46% (29/63 without symptoms) observed here. For other venomous snakes, such as vipers and elapids, it is reported that 20%&#x2013;50% of bites are &#x201c;dry&#x201d; (<xref ref-type="bibr" rid="B15">Pucca et&#xa0;al., 2020</xref>). However, the knowledge and expertise of the herpetocultural community should not be underestimated. Given that the snakes were kept as pets and that there are no other commonly kept species with which the iconic hognose could be confused, the identification can be considered accurate. The symptoms&#x2019; breadth, the abundance in which more intense cases are reported, and recovery times of several days exceed by far what is commonly expected from an <italic>H. nasicus</italic> bite. Rate and intensity of bite reaction was higher than expected. The observed symptoms are consistent with the suggested venom composition of <italic>H. nasicus</italic>. While svMP can lead to edema and pain, and can even cause blistering in rare cases, CRISPs are also known to promote inflammatory responses, leading finally to swelling, redness, and itching (<xref ref-type="bibr" rid="B18">Tadokoro et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B10">Mackessy, 2021</xref>).</p>
<p>While hypersensitivity/allergic reactions due to earlier snakebites are often raised concerns when NFFS bites are discussed, our data show that for <italic>H. nasicus</italic>, neither prior snakebites nor antihistaminic treatments affected the development of symptoms. Hence, the symptoms are based on a real envenomation by the Western Hognose (<italic>H. nasicus</italic>) toxins and not allergic reactions; antihistamines are not expected to be effective to treat snake envenomation in humans or other animals. The bite intensity is a major driver of symptom intensity. If an <italic>H. nasicus</italic> stayed attached to the bite site (extended bite) or even proceeds to chew, the percentage of patients with symptoms was 80% compared to 37% after strike only. This underlines the pivotal role of a holding/chewing movement for the effective transmission of venom, here directly shown for <italic>H. nasicus</italic> bites in humans. Regarding the age, younger <italic>H. nasicus</italic> (&lt;2 years) caused, in 60% of the reports, more symptoms than older individuals (40%). This could be linked to differences in venom amount or composition, but could also be explained by the tendency of younger snakes to be more defensive/insecure during handling. Either way, ontogenetic venom variation is known to be an important element of snake venom plasticity, but understudied in NFFS (<xref ref-type="bibr" rid="B16">Senji et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B9">Laku&#x161;i&#x107; et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B11">Mackessy and Saviola, 2016</xref>).</p>
<p>Handling or presenting food items with bare hands is a generally known reason for snakebites in pet care. A previous survey showed that 31% of <italic>H. nasicus</italic> keepers serve food with their bare hands (<xref ref-type="bibr" rid="B23">Zieli&#x144;ski, 2021</xref>), and also in the current survey, 16% of all bites followed skin contact with food items or other animals. In 50% of the cases, offering mice as well quail eggs and toads in some reports, bites caused edema and/or impaired joint movement, while the time to symptom resolution was not different in comparison to other bites. Even so, those numbers are too small for meaningful statistical analyses; they give a first indication that food item contact does not affect the general course of an <italic>H. nasicus</italic> bite. Considering that most bites are delivered to the hand and that symptom intensity is correlated to bite time exposure, it appears that virtually all <italic>H. nasicus</italic> envenoming can be prevented by proper handling equipment (e.g., leather gloves or snake hooks), quick removal of the snake after a bite, and by handling the snake particularly carefully during feeding (<xref ref-type="bibr" rid="B24">Zieli&#x144;ski, 2022</xref>; <xref ref-type="bibr" rid="B5">Foster et al., 2012</xref>; <xref ref-type="bibr" rid="B22">Wisconsin Herpetological Association, 2024</xref>). Therefore, <italic>H. nasicus</italic> is rated as between 2 and 3 on the hazard index with &#x201c;usually mild-to-mildly moderate local effects and often related to protracted bites&#x201d; with uncommon systemic envenoming, including no legal state regulations in any kind as a dangerous pet, but seen as a normal pet such as in the United States and Germany (<xref ref-type="bibr" rid="B21">Weinstein et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B14">Personal communication with international breeders and keepers, 2025</xref>). The development of a costly antivenom is therefore also far beyond what is necessary.</p>
</sec>
<sec id="s5" sec-type="conclusions">
<label>5</label>
<title>Conclusion</title>
<p>Although the <italic>H. nasicus</italic> is often acknowledged to be fully harmless, our retrospective survey indicates that the abundance and intensity of symptoms potentially caused by this snake exceeds what is commonly expected. While local pain and extensive edema are dominant, most cases progress into symptoms of several days&#x2019; resolution time. However, no sequelae are reported and no systemic envenomation has occurred. Therefore, albeit <italic>H. nasicus</italic> appears to be much more venomous to humans than previously reported, this species still should be considered relatively harmless as it is unable to cause permanent damage or fatalities. Most bite reports are linked to feeding context, and envenoming can be effectively prevented by careful handling with minor security equipment. In case of a bite, immediately removing the snake from the bite site reduces the chances of developing symptoms. From this perspective, there is no reason to initiate any legal regulations on this species due to its mild venom.</p>
</sec>
</body>
<back>
<sec id="s6" sec-type="data-availability">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Material</bold></xref>. Further inquiries can be directed to the corresponding authors.</p></sec>
<sec id="s7" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The studies involving humans were approved by Ethics Committee LEK FB 09, Justus-Liebig-Universit&#xe4;t Giessen, Giessen, Germany. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.</p></sec>
<sec id="s8" sec-type="author-contributions">
<title>Author contributions</title>
<p>MD: Investigation, Writing &#x2013; review &amp; editing, Funding acquisition, Conceptualization, Writing &#x2013; original draft, Data curation, Visualization, Methodology, Project administration. AV:&#xa0;Writing &#x2013; review &amp; editing, Funding acquisition, Writing &#x2013; original draft. BK: Investigation, Writing &#x2013; review &amp; editing, Writing &#x2013; original draft. TL: Conceptualization, Writing &#x2013; review &amp; editing, Writing &#x2013; original draft.</p></sec>
<ack>
<title>Acknowledgments</title>
<p>We thank Alejandra Centurion and Ignazio Avella for the Spanish translation of the survey and answers.</p>
</ack>
<sec id="s10" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
<p>The author TL declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.</p></sec>
<sec id="s11" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p></sec>
<sec id="s12" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors&#xa0;and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p></sec>
<sec id="s13" sec-type="supplementary-material">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/famrs.2026.1754226/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/famrs.2026.1754226/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Table1.xlsx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"/></sec>
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<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2770631">Deb Prasad Pandey</ext-link>, Agriculture and Forestry University, Nepal</p></fn>
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<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3015329">Ramesh Kumar</ext-link>, Indian Institute of Technology Delhi, India</p></fn>
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