Serum Sickness in Emergency Medicine Follow-up

  • Author: Susan M Chen, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 28, 2010
 

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.
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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.
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Complications

Complications of serum sickness may include the following:

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

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

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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 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

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  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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