eMedicine Specialties > Emergency Medicine > Allergy & Immunology

Serum Sickness: Follow-up

Author: Susan M Chen, MD, Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania Health System, Penn Presbyterian Medical Center
Contributor Information and Disclosures

Updated: Jul 9, 2009

Follow-up

Further Inpatient Care

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

Deterrence/Prevention

  • 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 material. 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 access 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.

Complications

  • Vasculitis
  • Neuropathy
  • Glomerulonephritis (rare)
  • Anaphylaxis
  • Shock
  • Death

Prognosis

  • Most cases are mild and resolve within a few days. However, subjective complaints and objective findings may persist for several weeks.

Miscellaneous

Medicolegal Pitfalls

  • The primary medical legal pitfall is not considering serum sickness in the differential diagnosis. Cessation of the offending antigen is important in the treatment of serum sickness.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous editor, Charles V Pollack, Jr, MD, to the development and writing of this article.



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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Further Reading

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Keywords

serum sickness, hypersensitivity reaction, type III hypersensitivity reaction, serum sickness reactions, foreign protein injection, antitoxin, tetanus horse serum, rabies horse serum, heterologous serum

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Contributor Information and Disclosures

Author

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.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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