Serum sickness in humans is a reaction to proteins in antiserum derived from a non-human animal source, occurring 5–10 days after exposure. Symptoms often include a rash, Arthralgia, fever, and lymphadenopathy. 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, such as penicillin.
Serum sickness may be diagnosed based on the symptoms, and using a blood test and a urine test. It may be prevented by not using an antitoxin derived from animal serum, and through prophylactic or . It usually resolves naturally, but may be treated with corticosteroids, antihistamines, Analgesic, and (in severe cases) prednisone. It was first characterized in 1906.
Signs and symptoms
Signs and symptoms can take as long as 14 days after exposure to appear.
They may include signs and symptoms commonly associated with hypersensitivity or infections. Common symptoms include:
Other symptoms include glomerulonephritis,
,
(enlarged
spleen),
hypotension (decreased
blood pressure), and in serious cases circulatory shock.
Complications
Rarely, serum sickness can have severe complications.
These include
neuritis,
myocarditis,
Laryngeal edema,
pleurisy, and Guillain–Barré syndrome.
Causes
Serum sickness is a type III hypersensitivity reaction, caused by
Immune complex.
When an
antiserum is given, the human
immune system can mistake the
present for harmful
. 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). They can be found circulating in the blood, which differentiates serum sickness from serum sickness-like reaction.
The result is a leukocytoclastic
vasculitis.
This results in hypocomplementemia, a low C3 level in serum.
They can also cause more reactions, causing the typical symptoms of serum sickness. This is similar to a generalised
Arthus reaction.
Antitoxins and antisera
Serum sickness is usually a result of exposure to
antibody derived from animals.
These sera or
are generally given to prevent or treat an
infection or
envenomation (venomous bite).
Drugs
Serum sickness may be caused by some routine
Medication. Some of the drugs associated with serum sickness are:
Others
Allergenic extracts,
hormones and
vaccines can also cause serum sickness. However, according to the Johns Hopkins Bloomberg School of Public Health, routinely recommended vaccinations to the general population in the U.S have not been shown to cause serum sickness, as of 2012.
Diagnosis
Diagnosis is based on history given by patient, including recent medications. A
blood sample may be taken and tested, which will show
thrombocytopenia (low
Platelet),
leukopenia (low white blood cells), high sedimentation of red blood cells, and a decrease in the complement proteins C3 and C4.
A urine sample may be taken and tested, which will show
proteinuria, and sometimes
hematuria (blood in the urine, with
hemoglobinuria).
Differential diagnosis
Similar skin symptoms may be caused by
lupus, erythema multiforme, and
hives.
Prevention
Avoidance of
Antitoxin that may cause serum sickness is the best way to prevent serum sickness.
Sometimes, the benefits of using an antitoxin outweigh the risks in the case of a life-threatening
Biting or sting. Prophylactic
or
may be used with an antitoxin. Skin testing may be used beforehand in order to identify individuals who may be at risk of a reaction.
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 is appropriate, or continue with prophylactic measures. This is important if a patient has received an antitoxin before, as the serum sickness caused can be worse and occur more quickly.
Treatment
Antiserum or drug treatment should be stopped as soon as possible.
Once treatment has stopped, symptoms usually resolve within seven days.
Outcomes are generally good.
Corticosteroid, Antihistamine, and analgesics are the main line of treatment.
Use of plasmapheresis has also been described.
Epidemiology
Serum sickness is becoming less common over time.
Many drugs based on animal serum have been replaced with artificial drugs.
History
Serum sickness was first characterized by Clemens von Pirquet and Béla Schick in 1906.
See also
External links
