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Serum sickness

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When a person experiences an allergic response after being exposed to certain antibiotics or antiserum, that person is said to have serum sickness. These substances usually contain protein antibodies like gamma globulin that are used as immunization agents to counter certain infectious diseases. People who have serum sickness will manifest symptoms four to fourteen days after exposure to antibiotics or antiserum.

SERUM SICKNESS DEFINITION

Serum sickness is actually a hypersensitivity to the antiserum's protein content, which is usually derived from animal sources. This type of hypersensitivity is known as type III immune complex hypersensitivity

When a person's immune system comes into contact with these foreign proteins in antibiotics or antiserums, it produces antibodies of its own to fight against these perceived invaders. These new antibodies collide and merge with the foreign proteins and develop into immune complexes. The immune complexes enter the blood vessel walls and result in an allergic inflammation.

Unlike other allergic reactions that manifest themselves immediately, serum sickness exhibits a delayed response. This is due to the period of time it takes the body to develop antibodies against these foreign proteins.

SERUM SICKNESS SYMPTOMS

A person with serum sickness will start exhibiting symptoms anywhere from four to fourteen days after exposure. Symptoms will manifest themselves as rashes on the palms of a person's hand and on the soles of their feet, and fever. In 50% of serum sickness cases, the afflicted person will also experience joint pain, or arthralgia, usually in the larger joints of the body.
Serum Sickness
Image: Serum Sickness


A person inoculated with antibodies who develops serum sickness will experience a swelling, enlargement, and tenderness of the lymph nodes within the area of the injection. In some cases, the neck and head of the afflicted individual may manifest some swelling. There will be an inflammation of the blood vessels, as well as traces of blood or protein in the person's urine.

Other symptoms of serum sickness include hypotension, or low blood pressure; an enlarged spleen; vision changes; breathing difficulties; edema, or swelling of the face, arm, and legs; movement difficulties, and anaphylactic shock. A person who has had a history of serum sickness may be affected with its symptoms again upon exposure to similar antibodies or antiserums.

When a person is exposed to the foreign proteins in an antibody or antiserum, their immune system reacts immediately. Serum is a clear fluid substance derived from the blood. Although it contains no blood cells, it is primarily composed of many different kinds of proteins, which include antibodies. These antibodies are meant to bolster the immune system's defence against invading infectious diseases.

SERUM SICKNESS TREATMENT

An antiserum on the other hand, is derived from an animal or human source that has exhibited a resistance against a certain infection. Antiserums are used to protect anyone who may be in danger of exposure to infectious microorganisms, particularly if they have had no history of immunization against these disease-causing bacteria.

When a person contracts serum sickness, it is because their immune system has often mistakenly identified the protein substances in an antiserum or an antibody as something harmful. The body's immune system then attacks these perceived foreign bodies, which results in all the symptoms of serum sickness, such as inflammation, fever and edema.

There are other medications, such as sulfa, penicillin or cefaclor, which can also bring on the symptoms of serum sickness. Unlike allergies to certain medications that manifest themselves immediately, serum sickness stemming from sulfa, penicillin or cefaclor start exhibiting symptoms between one to three weeks following exposure. Other injected medications, like antithymocyte globulin that is used for patients whose bodies reject transplanted organs, or rituximab, a drug designed for treatment of cancers and other immune disorders, may also cause serum sickness.

Other drugs that have been associated with serum sickness include barbiturates, allopurinol, cephalosporin antibiotics, captopril, phenytoin, quinidine, sulfonamide antibacterial medications, procainamide, and streptokinase. There have also been cases of blood products that have been known to result in serum sickness for some patients. While these medications and substances are not considered high-risk as they are administered to a lot of patients, a select few individuals may develop delayed allergies to them.

A doctor examining a patient with serum sickness will observe and take note of all the symptoms exhibited, as well as review the patient's medical history, paying particular attention to all the drugs and medications the patient has been exposed to in the past. Serum sickness may manifest the same symptoms as with other ailments; however, the main difference is that the patient has been exposed to a drug, antibody, or antiserum that has caused the delayed allergic reaction.

As soon as the doctor determines that the patient is suffering from serum sickness, the first step in treating this condition would be to cease the use of the medication, antibody or antiserum currently causing the serum sickness. The second step would be to treat the allergic manifestations of serum sickness. Depending on the severity of the patient's condition, the doctor may prescribe medications such as pain relievers, or anti-allergy drugs to counter the allergic reaction in the patient.


Corticosteriod creams and ointments are usually prescribed to relieve symptoms of itchiness and rashes, while antihistamines are the medicine of choice to cut short other allergy symptoms the patient experiences. For joint pain, the doctor may prescribe nonsteroidal anti-inflammatory drugs, like naproxen or ibuprofen, and in more severe cases, oral corticosteroids, such as prednisone are given to the patient.

SERUM SICKNESS PREVENTION

To prevent serum sickness from reccurring, a person who has a history of this condition will need to avoid antitoxins completely. They should inform the hospital or any medical personnel about this allergic reaction during any unrelated incidence of hospitalization or in the event of routine check-ups. For patients whose reactions have been exceptionally severe, wearing an identifying bracelet is strongly advised to alert medical personnel in the event of a hospital confinement.

In cases where an antitoxin or antiserum has to be administered due to necessity, a prior skin test may determine whether the person is allergic to it. During instances when there may not be enough time for a skin test, a person may be given an intravenous dosage of antihistamine together with the antitoxin or antiserum.
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