Drug-induced serum sickness

The drugs inducing serum sickness are sulfonamides, penicillin etc. Sulfonamides also cause Stevens-Johnson syndrome, a form of immune vasculitis, which is characterized by the reactions including arthritis, nephritis, myocarditis and certain mental symptoms. 

Plantin P, Milochau P, Dubois D. Nefrite interstiziale da farmaci. Descrizione di un caso clinico. [Drug-induced serum sickness after ingestion of cefatrizine. First reported case.] Presse Med 1992 21(40) 1915. 

C. Type III Drug Allergy Type III hypersensitivity is a complex type of drug allergy reaction that involves complement-fixing IgM or IgG antib ies and—possibly—IgE antibodies. Drug-induced serum sickness and vasculitis are examples of type III reactions Stevens-Johnson syndrome (associated with sulfonamide therapy) may also result from type III mechanisms. 

Type in hypersensitivity is mediated by soluble immune complexes mostly involving IgG antibodies. Drug-induced serum sickness-like reaction is the prototype example of type III drug hypersensitivity. Hypersensitivity vascu-Ms is another example of a type III hypersensitivity response induced by drugs. 

Antibiotics Isoniazid Penicillins Hypersensitivity and Autoimmunity Rash, dermatitis, vasculitis, arthritis, drug-induced SLE Anaphylaxis, dermatitis vasculitis, serum sickness, hemolytic anemia... 

Sulfonamides Dermatitis, photosensitivity pemphigus, hemolytic anemia, serum sickness, drug-induced SLE... 

Immune vasculitis can also be induced by drugs. The sulfonamides, penicillin, thiouracil, anticonvulsants, and iodides have all been implicated in the initiation of hypersensitivity angiitis. Erythema multiforme is a relatively mild vasculitic skin disorder that may be secondary to drug hypersensitivity. Stevens-Johnson syndrome is probably a more severe form of this hypersensitivity reaction and consists of erythema multiforme, arthritis, nephritis, central nervous system abnormalities, and myocarditis. It has frequently been associated with sulfonamide therapy. Administration of nonhuman monoclonal or polyclonal antibodies such as rattlesnake antivenin may cause serum sickness. 

General Indication Allergic disorders Principal Desired of Glucocorticoids Decreased inflammation Examples of Specific Disorders Anaphylactic reactions, drug-induced allergic reactions, severe hay fever, serum sickness... 

Type III reactions are caused by tissue injury due to immune complexes. The antigen-antibody complexes are usually cleared by the immune system however, repeated contact with antigens can cause the complex to deposit in tissue and result in tissue injury. Serum sickness is the classic example of a Type III reaction. Medications associated with serum sickness include many antibiotics, phenytoin, salicylates, barbiturates, nonsteroidal antiinflammatory drugs, isoniazid, antisera, hydralazine, captopril, and sulfonamides. Procainamide-induced lupus, described in Chapter 16, is also considered a Type III reaction. 

Despite a good overall safety profile, anti-TNF antibodies can induce a number of adverse effects, including autoimmunity and infections. A trial in the treatment of Crohn s disease noted infusion reactions, transient increased of anti-dsDNA antibodies, and serum sickness-like delayed hypersensitivity with retreatment. Induction of human-antichimeric-antibodies was suggested as the cause of some of the infusion reactions [90]. A prospective study in 35 patients with Crohn s disease showed induction of ANA and anti-dsDNA autoantibodies in 53% and 35% of infliximab-treated patients [91]. A single patient showed clinical features consistent with drug-induced lupus, including the presence of ANA and anti-dsDNA autoantibodies, which quickly resolved after discontinuation of infliximab. Reports on renal adverse effects of anti-TNF antibodies are very rare. Saint Marcoux described the occurrence of crescentic GN in as few as 2 patients out of a cohort of 39 patients, treated with an anti-TNF antibody for rheumatoid arthritis [92]. A case report by Chin et al. [93] described the case of a 29-year-old Australia-born Vietnamese who presented with nephrotic syndrome. A renal biopsy showed membranous nephropathy. Symptoms attenuated after discontinuation of infliximab therapy. 

Minocycline has better gastrointestinal absorption than tetracycline and may be less photosensitizing than either tetracycline or doxycycline. Side effects of minocycline include dizziness and hyperpigmentation of the skin and mucosa, serum-sickness-like reactions, and drug-induced lupus erythematosus. With all the tetracyclines, vaginal candidiasis is a common complication that is readily treated with local administration of antifungal drugs. 

Other adverse effects are caused by immunological reactions, of which the drug-induced lupus syndrome is the most common. Hydralazine also can result in an illness that resembles serum sickness, hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis the mechanism of these autoimmune reactions is unknown. The drug-induced lupus syndrome usually occurs after at least 6 months of continuous treatment with hydralazine, and its incidence is related to dose, sex,... 

This form of drug-induced urticaria is most commonly due to penicillin. The manifestations do not arise until at least 3-48 h after the dose of penicillin, and in some circumstances not until 3-4 days afterwards. Transitional forms between this condition and serum sickness are not uncommon clinically, the relationship is attested by the development of joint swellings. 

Examples of disease states Erythema urticaria angioedema respiratory symptoms GI symptoms anaphylaxis Drug-induced hemolytic anemia, thrombocytopenia, agranulocytosis (immune form) Serum sickness Drug-induced vasculitis Allergic contact dermatitis Psoriasis Maculopapular exanthema AGEP FDE DRESS SJS TEN EM... 

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