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Serum sickness

serum sickness, serum sickness in children
Serum sickness in humans is a reaction to proteins in antiserum derived from a non-human animal source, occurring 4–10 days after exposure It is a type of hypersensitivity, specifically immune complex hypersensitivity type III The term serum sickness-like reaction SSLR is occasionally used to refer to similar illnesses that arise from the introduction of certain non-protein substances, such as penicillin1 It was first characterized by Clemens von Pirquet and Béla Schick in 19062


  • 1 Causes
    • 11 Antitoxins and antisera
    • 12 Drugs
    • 13 Others
  • 2 Symptoms
  • 3 Diagnosis
  • 4 Treatment
  • 5 Prevention
  • 6 See also
  • 7 References
  • 8 External links


When an antiserum is given, the human immune system can mistake the proteins present for harmful antigens The body produces antibodies, which combine with these proteins to form immune complexes These complexes precipitate, enter the walls of blood vessels, and activate the complement cascade, initiating an inflammatory response and consuming much of the available complement component 3 C3 The result is a leukocytoclastic vasculitis This results in hypocomplementemia, a low C3 level in serum They can also cause more reactions resulting in typical symptoms of serum sickness

Antitoxins and antiseraedit

Serum sickness can be developed as a result of exposure to antibodies derived from animals These sera or antitoxins are generally administered to prevent or treat an infection or envenomation


Some of the drugs associated with serum sickness are:

  • allopurinol
  • barbiturates
  • captopril
  • cephalosporins
  • griseofulvin
  • penicillins
  • phenytoin
  • procainamide
  • quinidine
  • streptokinase
  • sulfonamides
  • rituximab
  • ibuprofen
  • infliximab


Allergenic extracts, hormones and vaccines can also cause serum sickness


Symptoms can take as long as 14 days after exposure to appear, and may include signs and symptoms commonly associated with hypersensitivity or infections

  • rashes
  • itching
  • joint pain arthralgia, especially finger and toe joints
  • fever, as high as 40 °C and usually appears before rash
  • lymphadenopathy swelling of lymph nodes, particularly near the site of injection, head and neck
  • malaise
  • hypotension decreased blood pressure
  • splenomegaly enlarged spleen
  • glomerulonephritis
  • proteinuria
  • hematuria
  • shock


Diagnosis is based on history given by patient, including recent medications


With discontinuation of offending agent, symptoms usually disappear within 4–5 days

Corticosteroids, antihistamines, and analgesics are the main line of treatment The choice depends on the severity of the reaction

Use of plasmapheresis has also been described3


Avoidance of antitoxins that may cause serum sickness is the best way to prevent serum sickness Although, sometimes, the benefits outweigh the risks in the case of a life-threatening bite or sting Prophylactic antihistamines or corticosteroids may be used concomitant with the antitoxin Skin testing may be done beforehand in order to identify individuals who may be at risk of a reaction Physicians should make their patients aware of the drugs or antitoxins to which they are allergic if there is a reaction The physician will then choose an alternate antitoxin if it's appropriate or continue with prophylactic measures

See alsoedit

  • Hypersensitivity
  • Arthus reaction
  • Serum sickness-like reaction


  1. ^ Brucculeri M, Charlton M, Serur D 2006 "Serum sickness-like reaction associated with cefazolin" BMC Clin Pharmacol 6: 3 PMC 1397863  PMID 16504095 doi:101186/1472-6904-6-3 
  2. ^ Jackson R October 2000 "Serum sickness" J Cutan Med Surg 4 4: 223–5 PMID 11231202 
  3. ^ Lundquist AL, Chari RS, Wood JH, et al May 2007 "Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review" Liver Transpl 13 5: 647–50 PMID 17377915 doi:101002/lt21098 

External linksedit

  • Serum sickness-like reactions

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Serum sickness

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