Serum sickness دکتر افشین شیرکانی فوق تخصص آسم و آلرژی و بیماری های نقص ایمنی عضو آکادمی آسم و آلرژی و ایمونولوژی آمریکا استادیار دانشگاه

ETIOLOGY III—Immune complex reactions 1–3 weeks after drug exposure (Cefaclor) Antigen-antibody/aggregates Blood vessels,liver, spleen,kidney, lung Complement, anaphylatoxin, Hypersensitivity pneumonitis

EPIDEMIOLOGY Common inciting agents include : blood products foreign proteins: antithymocyte globulin and antivenoms Medications: penicillin, sulfonamides, minocycline, cefaclor, hydantoins, and thiazides

CLINICAL MANIFESTATIONS Urticaria,Petechiae/Purpura(dorsal and palmar or plantar aspects of the hands and feet)/fever The symptoms of serum sickness typically occur 7 to 21 days after the administration of drugs, foreign proteins, or infections Symptom onset may be more rapid (within 1 to 4 days) in previously sensitized individuals polyarticular arthralgias, lymphadenopathy Carditis, glomerulonephritis, Guillain-Barresyndrome ,encephalomyelitis,and peripheral neuritis are rare complications

LABORATORY AND IMAGING STUDIES Elevated ESR Circulating immune complexes Depressed complement (C3 and C4) Skin biopsy( deposits of IgM, IgA, IgE, or C3) Hematuria or proteinuria

TREATMENT AND PREVENTION self-limited and resolves within 1 to 2 weeks Antihistamines to relieve pruritus NSAID drugs are given for fever and joint pain prednisone (1 to 2 mg/kg orally daily) Allergy skin testing does not predict the serum sickness development The primary means of prevention is to avoid exposure to the implicated cause