Serum sickness

Serum sickness
Classification and external resources
Specialty	emergency medicine
ICD-10	T80.6
ICD-9-CM	999.5
DiseasesDB	11970
MedlinePlus	000820
eMedicine	med/2105
MeSH	D012713

Serum sickness in humans is a reaction to proteins in antiserum derived from a non-human animal source, occurring 4–10 days after exposure. It is a type of hypersensitivity, specifically immune complex hypersensitivity (type III). The term serum sickness-like reaction (SSLR) is occasionally used to refer to similar illnesses that arise from the introduction of certain non-protein substances.^[1] It was first characterized by Clemens von Pirquet and Béla Schick in 1906.^[2]

Causes

When an antiserum is given, the human immune system can mistake the proteins present for harmful antigens. The body produces antibodies, which combine with these proteins to form immune complexes. These complexes precipitate, enter the walls of blood vessels, and activate the complement cascade, initiating an inflammatory response and consuming much of the available C3. The result is a leukocytoclastic vasculitis. They can also cause more reactions resulting in typical symptoms of serum sickness. This results in hypocomplementemia, a low C3 level in serum.

Antitoxins and antisera

Serum sickness can be developed as a result of exposure to antibodies derived from animals. These sera or antitoxins are generally administered to prevent or treat an infection or envenomation.

Drugs

Some of the drugs associated with serum sickness are:

Others

Allergenic extracts, hormones and vaccines can also cause serum sickness.

Symptoms

Symptoms can take as long as 14 days after exposure to appear, and may include signs and symptoms commonly associated with hypersensitivity or infections.

rashes
itching
joint pain (arthralgia), especially finger and toe joints
fever, as high as 104°F and usually appears before rash
lymphadenopathy (swelling of lymph nodes), particularly near the site of injection, head and neck
malaise
hypotension (decreased blood pressure)
splenomegaly (enlarged spleen)
glomerulonephritis
proteinuria
hematuria
shock

Diagnosis

Diagnosis is based on history given by patient, including recent medications.

Treatment

With discontinuation of offending agent, symptoms usually disappear within 4–5 days.

Corticosteroids, antihistamines, and analgesics are the main line of treatment. The choice depends on the severity of the reaction.

Use of plasmapheresis has also been described.^[3]

Prevention

Avoidance of antitoxins that may cause serum sickness is the best way to prevent serum sickness. Although, sometimes, the benefits outweigh the risks in the case of a life threatening bite or sting. Prophylactic antihistamines or corticosteroids may be used concomitant with the antitoxin. Skin testing may be done beforehand in order to identify individuals who may be at risk of a reaction. Physicians should make their patients aware of the drugs or antitoxins to which they are allergic if there is a reaction. The physician will then choose an alternate antitoxin if it's appropriate or continue with prophylactic measures.

References

↑ Brucculeri M, Charlton M, Serur D (2006). "Serum sickness-like reaction associated with cefazolin". BMC Clin Pharmacol 6: 3. doi:10.1186/1472-6904-6-3. PMC 1397863. PMID 16504095.
↑ Jackson R (October 2000). "Serum sickness". J Cutan Med Surg 4 (4): 223–5. PMID 11231202.
↑ Lundquist AL, Chari RS, Wood JH, et al. (May 2007). "Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review". Liver Transpl. 13 (5): 647–50. doi:10.1002/lt.21098. PMID 17377915.

External links

Serum sickness-like reactions

Complications of surgical and medical care (T80–T88, 996–999)

Transfusion reactions	Transfusion hemosiderosis TRALI TACO TA-GvHD FNHTR Acute/Delayed hemolytic transfusion reaction

Vaccine injury	Eczema vaccinatum

Other	Serum sickness Malignant hyperthermia Herxheimer reaction Graft-versus-host disease

Hypersensitivity and autoimmune diseases (279.5–6)

Type I/allergy/atopy
(IgE)

Foreign	Atopic eczema Allergic urticaria Allergic rhinitis (Hay fever) Allergic asthma Anaphylaxis Food allergy common allergies include: Milk Egg Peanut Tree nut Seafood Soy Wheat Penicillin allergy

Autoimmune	Eosinophilic esophagitis

Type II/ADCC

- IgM
- IgG

Foreign

Hemolytic disease of the newborn

Autoimmune

Cytotoxic	Autoimmune hemolytic anemia Immune thrombocytopenic purpura Bullous pemphigoid Pemphigus vulgaris Rheumatic fever Goodpasture's syndrome Guillain–Barré syndrome

"Type V"/receptor	Graves' disease Myasthenia gravis Pernicious anemia

Type III
(Immune complex)

Foreign	Henoch–Schönlein purpura Hypersensitivity vasculitis Reactive arthritis Farmer's lung Post-streptococcal glomerulonephritis Serum sickness Arthus reaction

Autoimmune	Systemic lupus erythematosus Subacute bacterial endocarditis Rheumatoid arthritis

Type IV/cell-mediated
(T cells)

Foreign	Allergic contact dermatitis Mantoux test

Autoimmune	Diabetes mellitus type 1 Hashimoto's thyroiditis Multiple sclerosis Coeliac disease Giant-cell arteritis Postorgasmic illness syndrome Reactive arthritis

GVHD	Transfusion-associated graft versus host disease

Unknown/
multiple

Foreign	Hypersensitivity pneumonitis Allergic bronchopulmonary aspergillosis Transplant rejection Latex allergy (I+IV)

Autoimmune	Sjögren's syndrome Autoimmune hepatitis Autoimmune polyendocrine syndrome APS1 APS2 Autoimmune adrenalitis Systemic autoimmune disease

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