It is characterized by a shorter latent period, exaggerated symptoms, and a brief clinical course. Wilson CB, Dixon FJ. Ann Allergy. Cheong J, Ooi K. Rituximab-induced serum sickness in the treatment of idiopathic membranous nephropathy. [Medline].
Erffmeyer JE. Adkinson NF Jr, Bochner BS, Burks W, et al, Eds. Neuroimaging with a computed tomography scan should be considered in patients with neurological complaints. Serum sickness is a self-limited entity that will usually resolve upon discontinuation of the offending agent, with or without additional treatment 41). [Full Text]. 1062-71. 602-16.
Richard Hariman, MD is a member of the following medical societies: American College of RheumatologyDisclosure: Nothing to disclose. 2002 Small complexes usually circulate without triggering inflammation, and large complexes are cleared by the reticuloendothelial system. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
JAMA.
The drug of choice for the treatment includes corticosteroids, antihistamines and analgesics. 2009 Jun;26(6):659-60.
Symptoms described in serum sickness include the following 31): Specific gastrointestinal symptoms may include abdominal pain, nausea, vomiting, or diarrhea 32). Desensitization protocol for rituximab-induced serum sickness. Antiserum is among the many proteins contained in plasma. J Pediatric Infect Dis Soc. Also, a complete review of systems, with a focus on each organ system and severity of symptoms, should be performed to evaluate for other potential causes of the patient’s presentation. The antigen type also plays a role in the possibility of onset of serum sickness. Ryan NM, Kearney RT, Brown SG, Isbister GK.
273(12):934-41. 233.
Thymoglobulin is an anti-thymocyte globulin drug derived from the rabbit. Serum creatinine may be elevated, but typically returns to baseline within days-weeks of discontinuing the offending agent. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Best Pract Res Clin Gastroenterol. A thorough history and physical exam are essential in the evaluation of suspected serum sickness. 2012 May-Jun;29(3):327-8.
Pilette C, Coppens N, Houssiau FA, Rodenstein DO. N Engl J Med. Lawley TJ, Bielory L, Gascon P, Yancey KB, Young NS, Frank MM. 2018 Jun. Vermeire S, Van Assche G, Rutgeerts P. Serum sickness, encephalitis and other complications of anti-cytokine therapy. [Medline]. Complications of serum sickness may include the following 46): To date, there have been no large-scale studies demonstrating any long-standing consequences of serum sickness. 166(1):68. Gamarra RM, McGraw SD, Drelichman VS, Maas LC. [Medline]. Immune system elements and the antiserum combine to form immune complexes, which cause the symptoms of serum sickness.
Susan M Chen, MD is a member of the following medical societies: American Academy of Emergency MedicineDisclosure: Nothing to disclose. 2002 Aug;85 Suppl 2:S607-12. Lawley TJ, Bielory L, Gascon P, Yancey KB, Young NS, Frank MM.
Karmacharya P, Poudel DR, Pathak R, Donato AA, Ghimire S, Giri S, et al. [Updated 2019 Jun 4]. 1995 Mar 22-29. The prognosis is relatively good except in serum sickness with involvement of internal organs. Samter M, ed. Arkachaisri T. Serum sickness and hepatitis B vaccine including review of the literature. 2002 Jan 8. Pediatr Dermatol. Trop. At this point, complement levels fall to half their levels prior to the antibody response 20). Sicherer SH, Leung DYM. If carditis is suspected, an electrocardiogram should be obtained.
Elaine Adams, MD is a member of the following medical societies: American College of Physicians, American College of RheumatologyDisclosure: Nothing to disclose. Serum sickness: Introduction. Clinical Immunology Principles and Practice. Lazoglu AH, Boglioli LR, Taff ML, Rosenbluth M, Macris NT. St. Louis, Mo: Mosby; 1996. With the erroneous recognition of antigen as harmful to the body, the immune system is stimulated to produce antibodies to fight off the deemed harmful substance in the body. A prospective clinical and immunologic analysis of patients with serum sickness.
Deterrence, Prevention, and Long-Term Monitoring, Association of Academic Chairs of Emergency Medicine. Incidence of reactions following administration of antirabies serum; study of 526 cases. Susan M Chen, MD Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania Health System, Penn Presbyterian Medical Center Also, the lab results in a serum sickness-like reaction will not show hypocomplementemia or renal dysfunction 40). The antiserum in serum sickness is isolated from non-human and when injected into the body is mistakenly recognized by the immune system as a foreign substance. 2006 May;26(5):705-8. https://emedicine.medscape.com/article/332032-overview. If you have been exposed to tetanus or rabies and have never been vaccinated against these germs. 2016 Aug. 117 (2):115-20. 18th ed. The protein in the serum is mistakenly identified by the immune system as a foreign particle in the body that should be warded off the body. The clinician should consider the following laboratory tests to evaluate for other etiologies and multi-organ system involvement: complete blood count with differential, erythrocyte sedimentation rate, C-reactive protein, total hemolytic complement (CH50), C3, C4, basic metabolic panel, liver transaminases, antinuclear antibody, and rheumatoid factor 39). 564-77. Dixon FJ, Cochrane CC. 2016 Aug. 16 (4):308-14. Ann Allergy Asthma Immunol. Hyg. Serum sickness is characterized by the triad of: Other symptoms may include the following: Serum sickness occurs following injection with antiserum.
Myalgias or myositis also may occur. 23(1):101-12. The inflammatory response of the body is the result of the activation of the immune system when it erroneously recognized the antiserum as a foreign protein which should be warded off from the body. 29 (4):449-450.
Serum sickness is also associated with mortality although this seldom happens. 29 (2):91-94. 1984 Nov 29. Pichler WJ. Generalized vasculitis occurs rarely. But it does contain many proteins, including antibodies, which are formed as part of the immune response to protect against infection. Serum sickness is a condition that happens in reaction to certain medications. google_ad_client: "ca-pub-9759235379140764", Anti-inflammatory drugs and antihistamines provide symptomatic relief. Immune Complex–Mediated Diseases. These reactions typically occur 1 to 3 weeks after exposure to the drug, but may occur as early as 1 to 24 hours afterward.
29 (4):449-450. It can equally affect both men and women and can occur to people from all over the world. Suwansrinon K, Jaijareonsup W, Wilde H, Benjavongkulchai M, Sriaroon C, Sitprija V. Sex- and age-related differences in rabies immunoglobulin hypersensitivity. Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of RheumatologyDisclosure: Nothing to disclose.
Philadelphia PA: Saunders; 2014. Severe cases with multisystem involvement with significant symptoms 13) may warrant a brief course of corticosteroids. In the extremities, eruptions occur at the junction of the palmar or plantar skin with the dorsolateral surface of the hands, feet, fingers, and toes. Anaphylaxis and serum sickness in patients receiving omalizumab: reviewing the data in light of clinical experience. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Secondary serum sickness is the result of antigen recognition by presensitized cells of the immune system. Although occasional reports show mortality resulting from progressive glomerulonephritis or severe neurological complications 12).
CMAJ. Drug allergy: an updated practice parameter. 2007 Aug. 48(8):1633-5. The inflammatory response of the body is the result of the activation of the immune system when it erroneously recognized the antiserum as a foreign protein which should be warded off from the body. Kliegman, ed.
CMAJ.
2009 Dec;60(12):3848-55.
4th ed. Eapen A, Kloepfer KM. [Medline]. 54 (1):27-33. Pediatr Allergy Immunol Pulmonol. Richard Hariman, MD Assistant Professor, Division of Rheumatology, Medical College of Wisconsin 2016.
Those with severe symptoms, recurrent serum sickness, or ongoing exposure to the causative agent may experience a prolonged course of illness. The evaluation of well-appearing patients with suspected serum sickness can be limited to urinalysis to determine the presence of kidney involvement, which would require close follow-up. Pediatr Allergy Immunol. [Medline]. If you log out, you will be required to enter your username and password the next time you visit.
Clin Kidney J. Immunological Diseases. More detailed information about the symptoms, causes, and treatments of Serum sickness is available below..
Online Edition, Chapter 149. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ Clark BM, Kotti GH, Shah AD, Conger NG. This website also contains material copyrighted by 3rd parties.
This may be facilitated by increased vascular permeability due to release of vasoactive amines from tissue mast cells 19). Generally, serum sickness resolves on its own and does not lead to any long-term complications. 2015 Jul.
Benson E. Bupropion-induced hypersensitivity reactions.
Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School 2003 Dec. 39(9):677-81. ... and products are for informational purposes only. 2007 Feb;101(2):206-8. 2009. Serum sickness is a type 3 immune-complex disease resulting from exposure to therapeutic heterologous (nonhuman) protein antigens or chimeric therapeutic proteins.
Incidence of immediate hypersensitivity reaction and serum sickness following administration of Crotalidae polyvalent immune Fab antivenom: a meta-analysis. Shulman ST. Clemens von Pirquet: A Remarkable Life and Career. Although occasional reports show mortality resulting from progressive glomerulonephritis or severe neurological complications. A close inspection of the rash may reveal an urticarial, maculopapular or vasculitic (purpuric) eruption. The antibodies and the antigens then bind together and mount up in the cell layers that line the blood vessels, lymph vessels and other parts of the body.
If you have been bitten by a snake that produces a dangerous toxin.
Rochella Abaygar Ostrowski, MD is a member of the following medical societies: American College of Physicians, American College of RheumatologyDisclosure: Nothing to disclose. Currently, the most common cause of serum sickness and serum sickness–like is hypersensitivity reaction to drugs 22). Eur. Finally, the antigen is no longer detectable, and the level of circulating antibodies continues to rise.
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