Serum sickness

Other drugs Nomifensin (Alival) Barbiturates Hydantoins Hydralazine  

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In type III or immunocomplex-mediated allergy, IgG antibodies form complexes with antigen. At low exposures, the body is able to remove diese complexes, but if there is a severe exposure, immunocomplexes release a variety of proinflammatory cytokines. The involvement of this mechanism is clearest in serum sickness. This mechanism is also considered to be most important in the development of extrinsic allergic alveolitis (hypersensitivity pneumonitis, especially... 

Serum sickness is an inflammatory condition caused by the deposition of immune complexes in blood vessel walls and tissues. 

Signs and symptoms resembling serum sickness-chills, fever, edema, joint and muscle pain, and malaise... 

Control of severe or incapacitating allergic conditions not controlled by other methods, bronchial asthma (including status asthmaticus), contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions... 

Some types of allergic reaction, for example immediate or delayed-type skin allergies, serum-sickness-like reactions and anaphylactic reactions, may occur in a proportion of patients given penicillin treatment. There is some, but not complete, cross-allergy with cephalosporins. 

Serum sickness. This occurs when there is an excess of anhgen to antibody, resulting in the formation of soluble complexes. These may circulate and cause systemic reactions or be widely deposited in the kidneys, joints and skin. A rise in temperature, swollen lymph nodes, a generalized urticarial rash and painful swollen joints occur. The rcpeated administration of foreign serum (e.g. antidiphtheria serum or antitetanus serum prepared in horses) can lead to this condition due to antibodies being produced to the horse protein material. 

The most frequent adverse effects are local reactions at the injection site (pain, tenderness, erythema, swelling, and pruritus), fevers (greater than 37.5°C or 99.5°F), headaches, dizziness, and irritability. Anaphylaxis and hypersensitivity reactions have been reported rarely and occur within a few hours after vaccine administration. In rare instances, a serum sickness-like apparent hypersensitivity syndrome (arthralgia, urticaria, ecchymoses, erythema multiforme, and erythema nodosum) has been... 

T cells control these learned responses and decide which tools to use in the reaction. Sometimes they choose several different tools at once, and multiple reactions ensue, such as when a person becomes sensitized to penicillin and has not only anaphylaxis but hemolytic anemia and serum sickness. There are different types of T cells, and they communicate either directly with other cells or by chemical messages called cytokines. The pattern of cytokines released is one way T cells have of determining which kind of response will occur. They are broadly called Thl andTh2 responses, with Thl mostly responding to infections and Th2 often producing allergy or asthma. 

These reactions involve a serum sickness like syndrome (e.g., arthralgias, fever, malaise, and urticaria) that usually develops 7 to 14 days after exposure to the causative antigen. 

Type III IgG and IgM Vasculitis, serum sickness, lupus Penicillins, sulfonamides, radiocontrast agents,... 

Adverse reactions CNS Convulsions, confusion, drowsiness, myoclonus, fever Dermatologic Rash Metabolic Electrolyte imbalance Hematologic Positive Coombs test, hemolytic anemia Local Rain, thrombophlebitis Renal Acute interstitial nephritis Miscellaneous Anaphylaxis, hypersensitivity, Jarisch-Herxheimer reaction CNS Seizures, confusion, drowsiness, myoclonus, CNS stimulation Cardiovascular Myocardial depression, vasodilation, conduction disturbances Hematologic Positive Coombs test, hemolytic anemia, neutropenia Local Thrombophlebitis, sterile abscess at injection site Renal Interstitial nephritis Miscellaneous Pseudoanaphylactic reactions, hypersensitivity, Jarisch-Herxheimer reaction, serum sickness... 

Prednisone 100 mg/M2 PO QD X 7 days start with ATG taper over 7 days if no serum sickness Cyclosporine 5 mg/kg/d divided BID taper by 1 mg/kg/month as tolerated... 

Although specific antisera have proven invaluable in the treatment of a variety of medical conditions (Table 13.1), they can also induce unwanted side effects. Particularly noteworthy is their ability to induce hypersensitivity reactions some such sensitivity reactions (e.g. serum sickness ) are often not acute, whereas others (e.g. anaphylaxis) can be life threatening. Because of such risks, antibody preparations derived from human donors (i.e. immunoglobulins) are usually preferred as passive immunizing agents. 

Advantages of crystalloids include rapidity and ease of administration, compatibility with most drugs, absence of serum sickness, and low cost. 

Infliximab has been associated with infusion reactions, serum sickness, sepsis, and reactivation of latent tuberculosis. Adalimumab carries risks similar to infliximab. 

Type III reactions are the result of antigen-antibody (IgG or IgM) complexes that accumulate in tissues or the circulation, activate macrophages and the complement system, and trigger the influx of granulocytes and lymphocytes (inflammation). Examples include an Arthrus reaction when soluble antigen is injected into the skin of a sensitized individual and serum sickness, which occurs 7 to 10 days following the administration... 

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... 

Treatment—Since C. botulinum toxin blocks the actions of nerves that activate muscles necessary for breathing, an antitoxin can be injected up to about 24 hours (based on monkey studies) after exposure to a lethal toxin dose and still prevent death. The two types of available antitoxins prepared from horse sera are trivalent (includes types A, B, E) and heptavalent (types A, B, C, D, E, F, and G) preparations. It should be noted that patients face a theoretical risk of developing serum sickness from such antitoxins. 

Type 3, immune complex vasculitis (serum sickness, Arthus reaction). Drug-antibody complexes precipitate on vascular walls, complement is activated, and an inflammatory reaction is triggered. Attracted neutrophils, in a futile attempt to phagocytose the complexes, liberate lysosomal enzymes that damage the vascular walls (inflammation, vasculitis). Symptoms may include fever, exanthema swelling of lymph nodes, arthritis, nephritis, and neuropathy. 

Allergic states Control of severe or incapacitating allergic conditions intractable to conventional treatment in serum sickness and drug hypersensitivity reactions. Parenteral therapy is indicated for urticarial transfusion reactions and acute noninfectious laryngeal edema (epinephrine is the drug of first choice). 

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