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Serum sickness

Drug allergy - serum sickness; Allergic reaction - serum sickness; Allergy - serum sickness

Serum sickness is a reaction that is similar to an allergy. The immune system reacts to medicines that contain proteins used to treat immune conditions. It can also react to antiserum, the liquid part of blood that contains antibodies given to a person to help protect them against germs or poisonous substances.

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Causes

Plasma is the clear fluid portion of blood. It does not contain blood cells. But it does contain many proteins, including antibodies, which are formed as part of the immune response to protect against infection.

Antiserum is produced from the plasma of a person or animal that has immunity against an infection or poisonous substance. Antiserum may be used to protect a person who has been exposed to a germ or toxin. For example, you may receive a certain type of antiserum injection:

During serum sickness, the immune system falsely identifies a protein in antiserum as a harmful substance (antigen). The result is an immune system response that attacks the antiserum. Immune system elements and the antiserum combine to form immune complexes, which cause the symptoms of serum sickness.

Certain medicines (such as penicillin, cefaclor, and sulfa) can cause a similar reaction.

Injected proteins such as antithymocyte globulin (used to treat organ transplant rejection) and rituximab (used to treat immune disorders and cancers) can cause serum sickness reactions.

Blood products may also cause serum sickness.

Symptoms

Unlike other drug allergies, which occur very soon after receiving the medicine, serum sickness develops 7 to 21 days after the first exposure to a medicine. Some people develop symptoms in 1 to 3 days if they have already been exposed to the medicine.

Symptoms of serum sickness can include:

Exams and Tests

The health care provider will perform an exam to look for lymph nodes that are enlarged and tender to the touch.

Tests that may be done include:

Treatment

Medicines, such as corticosteroids, applied to the skin may relieve discomfort from itching and a rash.

Antihistamines may shorten the length of the illness and help ease a rash and itching.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may relieve joint pain. Corticosteroids taken by mouth may be prescribed for severe cases.

The medicine that caused the problem should be stopped. Avoid using that medicine or antiserum in the future.

Outlook (Prognosis)

The symptoms usually go away within a few days.

Possible Complications

If you use the drug or antiserum that caused serum sickness again in the future, your risk of having another similar reaction is high.

Complications include:

When to Contact a Medical Professional

Call your provider if you received medicine or antiserum in the last 4 weeks and have symptoms of serum sickness.

Prevention

There is no known way to prevent the development of serum sickness.

People who have had serum sickness or drug allergy should avoid future use of the antiserum or drug.

Related Information

Immune response
Antibody
Protein in diet
Tetanus
Rabies
Allergies - overview
Antigen
Drug allergies
Anaphylaxis

References

Frank MM, Hester CG. Immune complex-mediated diseases. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 38.

Nowak-Wegrzyn A, Sicherer SH. Serum sickness. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 150.

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Review Date: 2/27/2018  

Reviewed By: Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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