eMedicine Specialties > Rheumatology > Vasculitis

Serum Sickness: Follow-up

Author: Hassan M Alissa, MD, Fellow in Rheumatology, Department of Internal Medicine, Loyola University Medical Center
Coauthor(s): Elaine Adams, MD, Chief of Medical Service, Chief of Rheumatology Section, Hines Veterans Affairs Hospital; Associate Chief, Associate Professor, Department of Internal Medicine, Loyola University School of Medicine; Rochella Abaygar Ostrowski, MD, Assistant Professor, Department of Medicine, Division of Rheumatology, Loyola University Medical Center; Staff Physician, Department of Medicine, Division of Rheumatology, Edward Hines Jr Veterans Affairs Hospital; Richard Hariman, MD, Fellow, Department of Rheumatology, Loyola University Medical Center
Contributor Information and Disclosures

Updated: Jun 22, 2009

Follow-up

Further Outpatient Care

  • Reconsider the diagnosis of serum sickness if symptoms persist beyond 3-4 weeks.
  • Symptoms may reappear in severe cases if steroids are tapered too quickly; this recurrence is usually responsive to another course of treatment.

Deterrence/Prevention

  • Withhold further use of the offending agent.
  • To identify patients who are at risk of anaphylactic reactions, test their skin using prick and intradermal testing at 1:1000 and then at 1:100 dilutions. However, these tests are not helpful for predicting which patients are at risk for developing serum sickness.
  • Premedication with steroids is not protective.

Complications

  • Severe progressive glomerulonephritis (rare)
  • Irreversible neurologic damage (rare)

Prognosis

  • Serum sickness is typically self-limited and resolves within days.9
  • The prognosis of serum sickness in the absence of internal organ involvement is good.1

Patient Education

  • After identifying the causative agent, inform the patient and advise that future exposure may cause a similar or more severe response.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider serum sickness in the differential diagnoses and to stop the offending agent
  • Readministration of an agent that has caused serum sickness in the past
 


More on Serum Sickness

Overview: Serum Sickness
Differential Diagnoses & Workup: Serum Sickness
Treatment & Medication: Serum Sickness
Follow-up: Serum Sickness
References
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References

  1. Pichler, WJ. Drug hypersensitivity. In: Rich RR, ed. Clinical Immunology Principles and Practice. 3rd ed. St Louis, Mo: Mosby/Elsevier; 2008:714.

  2. Mannik M. Serum sickness and pathophysiology of immune complexes. In: Rich RR, ed. Clinical Immunology Principles and Practice. St. Louis, Mo: Mosby; 1996:1062-71.

  3. Dixon FJ, Cochrane CC. Immune complex injury. In: Samter M, ed. Immunological Diseases. 4th ed. New York, NY: Little, Brown and Company; 1988:233.

  4. Sicherer SH, Leung DYM. Serum sickness. In: Kliegman, ed. Nelson Textbook of Pediatrics. 18th ed. Online Edition, Chapter 149.

  5. Erffmeyer JE. Serum sickness. Ann Allergy. Feb 1986;56(2):105-9. [Medline].

  6. King BA, Geelhoed GC. Adverse skin and joint reactions associated with oral antibiotics in children: the role of cefaclor in serum sickness-like reactions. J Paediatr Child Health. Dec 2003;39(9):677-81. [Medline].

  7. Abraham E, Wunderink R, Silverman H, et al. Efficacy and safety of monoclonal antibody to human tumor necrosis factor alpha in patients with sepsis syndrome. A randomized, controlled, double-blind, multicenter clinical trial. TNF-alpha MAb Sepsis Study Group. JAMA. Mar 22-29 1995;273(12):934-41. [Medline].

  8. Karliner JS, Belaval GS. Incidence of reactions following administration of antirabies serum; study of 526 cases. JAMA. Aug 2 1965;193:359-62. [Medline].

  9. Frank, MM, Lawley TJ. Immune complexes and allergic disease. In: Middleton E Jr, ed. Allergy Principles and Practice. 5th ed. St Louis, Mo: Mosby; 1998:704-6.

  10. Lawley TJ, Frank MM. Immune complexes and allergic diseases. In: Middleton E Jr, ed. Allergy Principles and Practice. 4th ed. St. Louis, Mo: Mosby; 1993:990.

  11. Lawley TJ, Bielory L, Gascon P, Yancey KB, Young NS, Frank MM. A prospective clinical and immunologic analysis of patients with serum sickness. N Engl J Med. Nov 29 1984;311(22):1407-13. [Medline].

  12. Pilette C, Coppens N, Houssiau FA, Rodenstein DO. Severe serum sickness-like syndrome after omalizumab therapy for asthma. J Allergy Clin Immunol. Oct 2007;120(4):972-3. [Medline].

  13. Disperati P, Hicks LK, Buckstein R. Rituximab-induced serum sickness in a patient with follicular lymphoma. Leuk Lymphoma. Aug 2007;48(8):1633-5. [Medline].

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Further Reading

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Keywords

serum sickness, hypersensitivity vasculitis, drug-induced vasculitis, immune complex disease, foreign serum, serum protein, serum disease, serum reaction, foreign proteins, haptens, antigens, leukocytoclastic vasculitis, secondary serum sickness, antirabies serum, tetanus antitoxin

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Contributor Information and Disclosures

Author

Hassan M Alissa, MD, Fellow in Rheumatology, Department of Internal Medicine, Loyola University Medical Center
Hassan M Alissa, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Elaine Adams, MD, Chief of Medical Service, Chief of Rheumatology Section, Hines Veterans Affairs Hospital; Associate Chief, Associate Professor, Department of Internal Medicine, Loyola University School of Medicine
Elaine Adams, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Nothing to disclose.

Rochella Abaygar Ostrowski, MD, Assistant Professor, Department of Medicine, Division of Rheumatology, Loyola University Medical Center; Staff Physician, Department of Medicine, Division of Rheumatology, Edward Hines Jr Veterans Affairs Hospital
Rochella Abaygar Ostrowski, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Nothing to disclose.

Richard Hariman, MD, Fellow, Department of Rheumatology, Loyola University Medical Center
Richard Hariman, MD is a member of the following medical societies: American College of Rheumatology
Disclosure: Nothing to disclose.

Medical Editor

John Varga, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Northwestern University
John Varga, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Central Society for Clinical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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