Serum Sickness Treatment & Management

  • Author: Hassan M Alissa, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Aug 30, 2011
 

Approach Considerations

Withdrawal of the offending agent is the mainstay of treatment in serum sickness. Anti-inflammatories and antihistamines provide symptomatic relief.

Severe cases (multisystem involvement with significant symptoms[15] ) may warrant a brief course of corticosteroids. In some cases, plasmapheresis can attenuate serum sickness.[5]

Hospitalize the patient if any significant comorbidities are present (eg, advanced or very young age, immunocompromise), if any severe symptoms or hemodynamic instability/hypotension is present, or if the diagnosis is unclear.

The presenting features of fever, rash, and joint pain may be observed in numerous infectious and autoimmune diseases. Consider a consultation with an allergist or a rheumatologist.

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Deterrence, Prevention, and Long-Term Monitoring

Avoidance of the offending agent is the best way to prevent serum sickness. However, in some circumstances, avoidance is not possible.

Skin tests are indicated before antiserum administration, particularly in patients with a history of allergy to horse dander or in those who have previously received the substance. Skin tests reveal the presence of immunoglobulin E antibodies and, thus, help to identify individuals at risk of anaphylaxis. However, these tests are not reliable in the identification of individuals with an increased risk for serum sickness.

If rapid administration of antiserum is necessary, establish intravenous access in each arm (one site for the infusion of antiserum and the other for the treatment of complications) and premedicate the patient with 50-100 mg of diphenhydramine (Benadryl). If a reaction occurs, temporarily discontinue the infusion, and administer epinephrine and other necessary medications. Once the adverse reaction is halted, resume slow infusion.

Premedication with steroids is not protective.

Long-term monitoring

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

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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 Rheumatology

Disclosure: Nothing to disclose.

Coauthor(s)

Susan M Chen, MD  Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania Health System, Penn Presbyterian Medical Center

Susan M Chen, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Elaine Adams, MD  Associate Chief of Staff, Chief of Rheumatology Section, Hines Veterans Affairs Hospital; Professor of 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  Assistant Professor, Division of Rheumatology, Medical College of Wisconsin

Richard Hariman, MD is a member of the following medical societies: American College of Rheumatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Matthew M Rice, MD, JD, FACEP  Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine

Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Washington State Medical Association

Disclosure: Team Health Salary Employment

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh 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: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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