serum sickness

Serum sickness is usually an iatrogenous or iatrogenic (that is, produced by medical treatment) condition. It once occured most often after the injection of horse serum antitoxins to treat such conditions as diphtheria or tetanus and poisonous snake or spider envenomation. Now it is most often a manifestation of a drug allergy. It can even follow beestings.

Serum sickness is what is called an "immune complex" disease. Antibody proteins attack antigens by latching on to them. These antigen-antibody "immune complexs" are deposited in the small vessels and filtering organs of the body where they trigger a local immune reaction. Eventually they are gobbled up and destroyed by immune cells, and the damage heals.

Serum sickness usually begins about 7 to 12 days following injection of the foreign material but may appear as late as 3 weeks afterward. Repeat exposures may produce the reaction within 1 to 3 days. Fever, malaise, and skin rashes are characteristic. Urticaria (hives) is common. Swelling, especially around the face and neck, facial flushing, muscle pain, lymph node swelling, joint pain, or arthritis involving multiple joints (ankle, knee, wrist, fingers, toes), and complaints of abdominal cramping, diarrhea, and nausea also occur. In cases of serum sickness caused by antitoxin injection, the injection site where the antitoxin was given usually becomes red and swollen a few days before other symptoms begin.

Serum sickness generally runs a benign and self-limited course. The patient recovers in 7-10 days. Carditis (inflammation around the heart) and kidney inflammation occur rarely; the most serious complications of serum sickness are nerve conditions such as Guillain-Barre syndrome and peripheral neuritis.

The usual treatment is aspirin and antihistamines. Severe symptoms may require the use of steroid medications. Plasma cleansing (plasmapheresis) is rarely used for severe serum sickness not responsive to the usual measures.

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