What is Serum Sickness?

Serum disease is a type III allergy caused by infusion of xenogeneic serum. In the broad sense, serum disease refers to the above-mentioned reactions caused by foreign antigens, and some people call them serum-like reactions. It is clinically common in patients treated with ATG / ALG prepared from rabbit or horse serum. The antibody globulins that make up the sero-immune complex are mainly IgG, but if there is more IgE, the increase in serum permeability at the time of onset is more obvious. May have throat edema, hypotension and even anaphylactic shock. Those who are more likely to produce IgG and IgE antibodies under antigen stimulation are also more likely to develop serum disease. At present, the serum preparations that cause serum sickness in the clinic mainly include tetanus antitoxin, diphtheria antitoxin, various snake venom antitoxins, and anti-lymphocyte globulin (ATG). The drugs that cause serum sickness are mainly penicillin, streptomycin, sulfonamides, and water. Macromolecular drugs such as salicylate, acetone, phenytoin, and dextran.

Basic Information

English name

serum sickness

Visiting department

Division of Rheumatology

Common causes

Xenotransfusion

Common symptoms

Urticaria-like wind mass, purpuric rash or measles-like rash, etc.

Serum etiology

The disease usually occurs within 1 to 2 weeks after a large dose of heterologous serum or globulin is injected. A small number of patients, especially those with a history of the same serum vaccination in the past, can occur within 1 to 2 days or even minutes after vaccination.

Clinical manifestations of serum disease

The occurrence and extent of symptoms are related to factors such as the route of vaccination (the incidence of intravenous injection is more) and the dose of serum injected. The clinical manifestations of sera due to the injection of serum are generally mild. Often after 3 to 5 days, as the level of allogeneic serum gradually decreases, the symptoms gradually disappear.

Rash is the most obvious and common symptom of the disease, mainly urticaria-like wind mass, purpuric-like rash or measles-like rash; it usually occurs first at the injection site. Fever gradually started, as high as 38 ~ 39 , with varying degrees of swelling of lymph nodes throughout the body, soft and slightly tender. Some patients may also have edema of the face, eyelids, and end of hands and feet (most common in children), and very few patients may have edema of the throat. Some patients have abdominal pain, nausea, and vomiting in the same fashion as fever. It is caused by serum or globulin (such as ATG) or other macromolecular drugs. Two days after the rash appears, joint pain, swelling and other arthritic symptoms can also occur, often involving multiple joints, showing symmetry. There are few serious complications such as polyneuritis, glomerulitis, and / or myocarditis.

Serum disease test

Laboratory tests are not very helpful for this disease. Normally, the total number of white blood cells may increase moderately, but the number of eosinophils increases. Both serum total complement and C3 can be decreased, and sometimes immune complexes can be found in the blood. Although these can help diagnose the disease, they are not very specific.

Serology diagnosis

The diagnosis of this disease is based on the history of serum or globulin injection and the above-mentioned characteristic clinical manifestations. Small-molecule drugs rarely cause neuritis, glomerulitis, or / and systemic lymphadenopathy.

Serotherapy

Generally speaking, the symptoms of this disease are not severe and self-limiting. Therefore, symptomatic treatment should be given priority. Fever or joint pain can be used salicylic acid preparation. Diphenhydramine can be used in patients with rash, and 10% calcium gluconate is administered intravenously daily. Subcutaneous injection of 0.1% epinephrine is very effective for angioedema, wheezing or severe urticaria, and can be repeated every half an hour if necessary.

Children receiving diphtheria antitoxin serum injections in sufficient amounts of antihistamines on the 4th to 16th days can significantly reduce the incidence of serum sickness.

Severe patients involving the nervous system, kidneys, or other internal organs should be treated with adrenal corticosteroids. Adults can be injected with hydrocortisone intravenously (or an equivalent dose of prednisone orally). After 2 to 3 days, gradually reduce the dose depending on the condition.