Serum sickness is a systemic allergic reaction that develops during sensitization to foreign proteins entering the body with serums, vaccines, blood components, and medications. The disease is manifested by polymorphic rash, angioedema, enlarged lymph nodes, fever, in severe cases – anaphylactic reaction. Diagnosis involves a thorough collection of anamnesis, analysis of clinical symptoms and laboratory data. Treatment includes the relief of systemic manifestations of allergies, the use of antihistamines, glucocorticosteroids, anti-inflammatory and sedatives.
ICD 10
T80.6 Other serum reactions
General information
Serum sickness refers to allergic diseases with an immunocomplex type of reaction, occurs in response to the introduction of foreign serums, individual protein fractions and certain medications. In this case, the pathological process extends to various organs and tissues of the body, including the skin, kidneys, heart muscle, joints. Hypersensitivity to parenterally administered vaccines and serums occurs in about 1-2% of cases of drug allergy. The disease was first described by the Austrian immunologist Pirke in 1902.
Causes
The occurrence of the disease is associated with parenteral administration of foreign protein components and drugs into the body, leading to the development of a systemic allergic reaction. The most common causal factors include:
- Foreign proteins of serums, vaccines. More often these are heterogeneous (prepared from the blood of immunized animals), less often – homologous (from the blood serum of ill or immunized people) preparations. Allergic reactions can develop with the introduction of anti–diphtheria, tetanus, anti-gangrenous, anti-botulinum, antistaphylococcal, anti-snake serum, antileptospirosis immunoglobulin and other drugs, occasionally – with the use of human immunoglobulins and monoclonal antibodies.
- Some medications: beta-lactam antibiotics of the penicillin series, cephalosporins, sulfonamides (clotrimazole), cytostatics and some nonsteroidal anti-inflammatory drugs, individual preparations containing iodine and bromine.
Adverse factors that increase the likelihood of developing serum sickness and its complications include hereditary predisposition, including the detection of immunological markers – DR-4, B-13HLA antigens. The presence of concomitant diseases accompanied by secondary immunodeficiency, as well as taking certain medications (for example, beta-blockers), aggravates the course of allergies.
Pathogenesis
Serum sickness is characterized by an immunocomplex type of allergic reactions. At the same time, in response to the first administration of a vaccine or serum, specific antibodies are synthesized in the body, which, upon repeated contact with the allergen, form circulating immune complexes that are fixed on the inner wall of blood vessels. In the future, the pathological process leads to the activation of complement; its components (C3a, C4a and C5a) cause an increase in vascular permeability, attract neutrophils to circulating immune complexes, resulting in an inflammatory process of the type of systemic vasculitis. Most often there is a lesion of the renal vessels (renal glomeruli with the development of glomerulonephritis), as well as coronary and pulmonary arteries.
Symptoms of serum sickness
Clinical symptoms, as a rule, appear 7-20 days after intravenous or intramuscular administration of a foreign protein that is part of a vaccine, serum, immunoglobulin, or drug. The body of sensitized individuals reacts to the repeated administration of the antigen in a shorter time – after a few hours or days. The symptoms of serum sickness are diverse and depend on the type of drug administered and its antigenic activity, the reactivity of the immune system, the presence of concomitant diseases and other factors.
The first signs of the disease can be noticed already on the 1st-2nd day after the introduction of the vaccine or drug, which is manifested by limited hyperemia (redness), swelling or itching at the injection site, the appearance of small rashes on the skin. 1-3 weeks after the introduction of a foreign protein, a general reaction of the body develops with hyperthermia up to 39-40 ° C, an increase in lymph nodes, changes in the skin by the type of urticaria and Quincke’s edema, as well as in the form of scarlet fever, papular, less often hemorrhagic rash, which can spread throughout the body.
The pathological process in serum sickness often extends to the medium and small joints of the upper and lower extremities (elbow and wrist, knee, ankle, as well as small joints of the hands and feet). At the same time, there is swelling and soreness, a decrease in the volume of movements in the joints affected by the inflammatory process.
There is a violation of the function of the cardiovascular system (due to the development of vasculitis with damage to the coronary arteries), which is manifested by prolonged pain behind the sternum and in the heart area, shortness of breath with little physical exertion, a decrease in blood pressure, tachycardia, general weakness.
Damage to the endothelium of the renal vessels by immune complexes circulating in the blood leads to the development of a chronic inflammatory process in the glomeruli – glomerulonephritis, which is characterized by a progressive course with the presence of secondary arterial hypertension, widespread edematous syndrome, renal failure.
Depending on the severity, several forms of the course of serum sickness are distinguished. The mild form occurs in 50% of patients and is manifested by a slight violation of general well-being with subfebrile temperature, localized rash, and an increase in regional lymph nodes. In moderate to severe forms, a violation of the general condition is more pronounced (headaches, fever, decreased blood pressure, nausea and vomiting, diarrhea). At the same time, there is a lesion of the skin of the whole body, pain behind the sternum, in the joints and lumbar region, shortness of breath, decrease and loss of working capacity, and the duration of the disease is from 1 to 3 weeks or more.
Complications
Complications of serum sickness include the development of anaphylactic shock in response to repeated intravenous administration of foreign serum. Symptoms are manifested by a sudden decrease in blood pressure and hyperthermia, the appearance of convulsive syndrome, loss of consciousness, spontaneous urination and defecation. In the absence of timely emergency care, the death of the patient often occurs. Significantly aggravates the course of serum sickness and the appearance of signs of damage to internal organs with the development of myocarditis and endocarditis, exudative pericarditis, nephritis, encephalitis and meningitis, Guillain–Barre syndrome and other diseases.
Diagnostics
The correct diagnosis is established as a result of the analysis of anamnestic data, clinical examination and laboratory tests:
- Anamnesis. It includes the study of information about allergic diseases suffered, the presence of the fact of the introduction of a vaccine or serum shortly before the onset of allergy symptoms.
- Clinical examination. The allergist-immunologist identifies the characteristic signs of serum sickness: local changes on the skin around the injection site of the drug, hyperthermia, symptoms of damage to internal organs, joints, etc. If necessary, consultations of a cardiologist, a nephrologist, a rheumatologist, an infectious disease specialist are appointed.
- Laboratory tests. Signs of leukocytosis or leukopenia, relative lymphocytosis, neutropenia, sometimes an increase in the number of eosinophils and plasmocytes, a decrease in the number of platelets can be detected in the blood. In the blood serum, an increase in the concentration of C-reactive protein, an increase in AlAT and AsAT is often determined. In the urine, when the glomeruli of the kidneys are affected, proteinuria, microhematuria are detected, hyaline cylinders appear.
- Allergological studies. Most often, the concentration of circulating immune complexes, complement components is determined by methods of enzyme immunoassay (ELISA), immunodiffusion. The Shelley basophil test is performed, IgE antibodies to penicillin antibiotics are determined, a lymphocyte transformation test and other studies are performed.
Differential diagnosis of serum sickness is carried out with other allergic diseases, infections, skin diseases, rheumatism, glomerulonephritis.
Treatment of serum sickness
A specific plan of therapeutic measures is drawn up by a specialist in the field of clinical allergology. In each case, it is individual, taking into account the severity of the course, the presence of complications, concomitant diseases, the age of the patient. The basic principles of treatment include:
- Cancellation of problematic medicines. Discontinuation of the administration of serums, penicillin preparations and other pharmacological agents that cause increased sensitivity of the body.
- Prompt removal of allergens. It is recommended to carry out infusion therapy, taking a large amount of liquid, cleansing enema, prescribing laxatives and enterosorbents.
- Compliance with a hypoallergenic diet. A short-term hunger break or a fasting day is appointed, then a meal is carried out with the exception of potential allergens.
- Taking antihistamines. With a mild course of serum sickness, drugs are prescribed orally, with moderate and severe forms – parenterally.
- Glucocorticoid hormones. Reception is carried out in an individually selected dose for 1-2 weeks inside or intramuscularly.
In case of anaphylactic shock, emergency measures are carried out with mandatory hospitalization of the patient to the hospital and subsequent observation for 3-5 days. Symptomatic therapy is prescribed in the presence of signs of damage to internal organs and joints. Nonsteroidal anti-inflammatory drugs, anticoagulants, diuretics, sedatives, etc. are used.
Prognosis and prevention
With timely access to an allergist and adequate therapy, serum sickness in most cases ends with recovery within 1-3 weeks. With the development of severe complications (anaphylactic shock, renal failure, meningitis and encephalitis, endocarditis, etc.), the prognosis worsens.
Prevention is based on conducting explanatory work among the population, improving the quality of vaccines, serums, immunoglobulins, antibiotics, limiting the use of drugs based on horse serum, improving the equipment of medical institutions with diagnostic tools and emergency care for allergic diseases.
