Serum sickness

Video explanation
Specialty| Immunology
Symptoms| Fever, rash, joint pain[1]
Duration| Few weeks[1]
Causes| Certain vaccines (such as rabies), antivenom, immunomodulators (such as rituximab or thymoglobulin)[1][2]
Diagnostic method| Blood tests, skin biopsy[2]
Differential diagnosis| Serum sickness–like reaction (SSLR), acute rheumatic fever, Kawasaki disease, Dengue, Stevens-Johnson syndrome, IgA vasculitis[1][2]
Treatment| Stopping the cause, antihistamines, NSAIDs, steroids, plasma exchange[1][2]
Prognosis| Good[1]
Frequency| Rare[1]

Serum sickness is a type of allergic reaction to non-human proteins.[2] Symptoms commonly include fever, rash, and joint pain.[1] It generally occurs 7 to 14 days after exposure and symptoms can last for a few weeks.[1] Complications are rare, though repeated episodes of serum sickness may potentially result in kidney failure.[1]

It most commonly occurs as a result of certain vaccines (such as rabies), antivenom, and immunomodulators (such as rituximab and thymoglobulin).[1][2] The underlying mechanism involves hypersensitivity, specifically immune complex hypersensitivity (type III).[2] Diagnosis may be supported by urine tests, blood tests, and a skin biopsy.[1][2]

Treatment often simple involves stopping whatever is causing the condition.[1] Antihistamines and NSAIDs may be used to improve symptoms.[1] For more severe symptoms steroids may be used.[1] If this is not effective plasma exchange may be an option.[2] Outcomes are generally excellent.[1]

Serum sickness is rare.[1] It; however, may occur in up to 27% of people treated with thymoglobulin post kidney transplant.[2] It was first described in detail by Clemens von Pirquet and Béla Schick in 1905.[3]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 2.1 Antitoxins and antisera
* 2.2 Medications
* 2.3 Others
* 3 Diagnosis
* 3.1 Differential diagnosis
* 4 Prevention
* 5 Treatment
* 6 See also
* 7 References
* 8 External links

## Signs and symptoms[edit | edit source]

a) Multiple itchy and red and some targeted lesions are seen on lower extremities b) the injection site on the back

Signs and 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 40 °C 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
* protein in the urine
* blood in the urine
* shock

## Causes[edit | edit source]

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 complement component 3 (C3). The result is a leukocytoclastic vasculitis. This results in hypocomplementemia, a low C3 level in serum. They can also cause more reactions resulting in typical symptoms of serum sickness.

### Antitoxins and antisera[edit | edit source]

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.

### Medications[edit | edit source]

Some of the drugs associated with serum sickness are:

* allopurinol
* barbiturates
* captopril
* cephalosporins
* crofab
* griseofulvin
* penicillins
* phenytoin
* procainamide
* quinidine
* streptokinase
* sulfonamides
* rituximab
* ibuprofen
* infliximab
* oxycodone

### Others[edit | edit source]

Allergenic extracts, hormones and vaccines can also cause serum sickness. However, according to the Johns Hopkins Bloomberg School of Public Health, currently routinely recommended vaccinations to the general population in the U.S have not been shown to cause serum sickness. [1] Archived 2018-10-28 at the Wayback Machine

## Diagnosis[edit | edit source]

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

### Differential diagnosis[edit | edit source]

Serum sickness–like reaction (SSLR) is a similar illnesses that arise from the introduction of certain non-protein substances, such as penicillin.[4]

## Prevention[edit | edit source]

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.

## Treatment[edit | edit source]

With discontinuation of the offending agent(s), 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.[5]

## See also[edit | edit source]

* Arthus reaction

## References[edit | edit source]

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 Rixe, N; Tavarez, MM (January 2020). "Serum Sickness". PMID 30855896. `{{cite journal}}`: Cite journal requires `|journal=` (help)
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 "Serum sickness". dermnetnz.org. DermNet NZ. Archived from the original on 3 March 2021. Retrieved 14 February 2021.
3. ↑ Jackson R (October 2000). "Serum sickness". J Cutan Med Surg. 4 (4): 223–5. doi:10.1177/120347540000400411. PMID 11231202.
4. ↑ 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. Archived from the original on 2015-11-25. Retrieved 2008-09-10.
5. ↑ 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[edit | edit source]

Classification|

* ICD-10: T80.6
* ICD-9-CM: 999.5
* MeSH: D012713
* DiseasesDB: 11970

|

External resources|

* MedlinePlus: 000820
* eMedicine: med/2105

* Serum sickness-like reactions Archived 2010-09-04 at the Wayback Machine

* v
* t
* e

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

* v
* t
* e

Hypersensitivity and autoimmune diseases

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 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 syndrome
* Autoimmune hepatitis
* Autoimmune polyendocrine syndrome
* APS1
* APS2
* Autoimmune adrenalitis
* Systemic autoimmune disease

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