1. Serum Sickness Mai Nguyen
Mercer University COPHS Doctor of Pharmacy Candidate 2012
June 9, 2011
Preceptor: Dr. Ali Rahimi

2. Overview Serum sickness is a reaction similar to an allergy.
Specifically, type III hypersensitivity reaction to certain medications, injected proteins used to treat immune conditions, or antiserum
Antiserum: liquid part of blood that contains antibodies that help protect against infectious or poisonous substances
Example: Tetanus vaccine

3. Introduction of antigen
Pathophysiology
Introduction of antigen
Body’s immune system responds by synthesizing antibodies after 4-10 days
Antibody reacts with antigen, forming soluble complexes that may diffuse into vascular walls and may initiate activation of complement

4. Proteolytic enzymes that can mediate tissue damage are released
Pathophysiology
Complement-containing immune complexes generate influx of leukocytes into vessel walls
Proteolytic enzymes that can mediate tissue damage are released
Immune complex deposition + inflammatory response are responsible for vasculitic lesions seen in SS

5. Causes Antiserum Tetanus or rabies vaccination Medications PCN Sulfa
Unlike other drug allergies, which occur very soon after receiving the medication again, SS develops 7-21 days after the first exposure to medication
Injected proteins
Antithymocyte globulin (ATG) - treat organ transplant rejection
Rituximab – mAb treats immune disorders and cancers
Blood products

6. Symptoms Fever Rash Muscle aches Swollen lymph nodes Hives
Difficulty breathing
Itching
Edema
Joint pain

7. Signs and Tests Lymph nodes may be enlarged and tender to touch.
Urine may contain blood or protein.
Blood tests may show immune complexes or signs of blood vessel inflammation
Elevated erythrocyte sedimentation rate
Leukocytosis

8. Treatment
Corticosteroid creams or ointments – relieve discomfort from itching and rash
Antihistamines – may shorten length of illness and help ease rash and itching
NSAIDS – may relieve joint pain
Tylenol – helpful in relieving fever and muscle pain
Medications causing problem should be stopped and future use should be avoided.

9. Complications and Prognosis
Vasculitis
Neuropathy
Anaphylaxis
Shock
Death
Most cases are mild and resolve within a few days.
Symptoms may persist for several weeks.
Fatalities are rare and usually are due to continued administration of the antigen.

10. References
Chen SM. (2010). Serum Sickness in Emergency Medicine. Medscape. Retrieved from
article/ overview
Henochowicz, SI. (2011). Serum Sickness. PubMed Health. Retrieved from