Serum-like disease

Morbilliform exanthema differs markedly in morphological appearance and clinical evolution from the urticarial reaction described above. The skin lesions usually remain stable for a few days (instead of a few hours) and disappear promptly within a few days of interruption of penicillin treatment. It is not rare, however, to observe a mixture of both forms in the same patient. 

Morbilliform exanthema is tending to become the most frequent form of adverse reaction to penicillins (Table 3), but it is likely that this trend represents above all the increase of rashes following ampicillin treatment (for review see Al-MEYDA and Levantine 1972 Dewdney 1980 Bass et al. 1973 Beckmann 1971). 

a number of questions on ampicillin rash remain open. The role of protein impurities has been pointed out (Knudsen et al. 1970). Both experimentally (Shal-TiEL et al. 1971 Batchelor and Dewdney 1968) and clinically (Knudsen et al. 1970 Parker and Richmond 1976), it has been claimed that purification of ampicillin would markedly reduce the frequency of rash. However, the rash is also observed with ampicillin preparations where the side chain splitting from 6-APA has been achieved by chemical means (A. L. de Weck, unpublished work). The role of ampicillin polymers, which are now available in isolated form (Bundgaard 1978), should be reinvestigated. 

The immunological mechanism of the ampicillin rash also remains a controversial topic. Several authors favor the concept that such exanthemas are indeed a 

Reported association between high levels of penicillin-specific IgM antibodies and exanthema (not confirmed). 

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Generalized urticaria Anaphylactic shock Anaphylactoid symptoms Serum-like disease Angioneurotic edema Generalized exanthema Contact eczema Blood dyscrasias Pruritus Local reactions Asthma Others... 

Occurrence possible earlier than serum-like disease (5th instead of 9th day). 

Increase in blood and urine Mo levels, increases in serum ceruloplasmin, increased xanthine oxidase activity (11) Increased uric acid, decreased copper excretion, high incidence of gout-like disease (11)... 

The underlying mechanism of a series of clinical entities associated with beta-lactams, such as maculopapular rash, drug fever, eosinophilia, serum sickness-like disease, vesicular and bullous skin reactions, erythema nodosum, and acute interstitial nephritis, is suspected to be immunological but is still largely unknown. 

Vial T, Pont J, Pham E, RabiUoud M, Descotes J. Cefaclor-associated serum sickness-like disease eight cases and review of the literature. Ann Pharmacother 199226(7-8) 910-14. 

Infliximab Anti-TNFa Ab - Rheumatoid arthritis -Crohn s disease -Ankylosing spondylitis - Serum sickness - Lupus-like disease - Extracapillary glomerulonephritis 90-93... 

In addition, silicone-containing medical devices, particularly breast prostheses, have been reported to cause serum-sickness-like reactions, scleroderma-like lesions, and an SLE-like disease termed human adjuvant disease [11,23]. Some patients may also present with granulomas and autoantibodies. Human adjuvant disease is a coimective tissue or autoimmune disease similar to that of adjuvant arthritis in rats and rheumatoid arthritis in humans. Autoimmime disease-like symptoms usually develop 2-5 y after implantation in a small percentage of people that receive implants, which may indicate that there is a genetic predisposition similar to that for... 

Serum-sickness-like disease 1-3 weeks Urticaria, fever arthralgias, adenopathies IgG and IgE BPO and minor determinants... 

Diabetic patients have reduced antioxidant defences and suffer from an increased risk of free radical-mediated diseases such as coronary heart disease. EC has a pronounced insulin-like effect on erythrocyte membrane-bound acetylcholinesterase in type II diabetic patients (Rizvi and Zaid, 2001). Tea polyphenols were shown to possess anti-diabetic activity and to be effective both in the prevention and treatment of diabetes (Choi et al, 1998 Yang et al, 1999). The main mechanism by which tea polyphenols appear to lower serum glucose levels is via the inhibition of the activity of the starch digesting enzyme, amylase. Tea inhibits both salivary and intestinal amylase, so that starch is broken down more slowly and the rise in serum glucose is thus reduced. In addition, tea may affect the intestinal absorption of glucose. 

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