eMedicine Specialties > Emergency Medicine > Allergy & Immunology

Serum Sickness: Treatment & Medication

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

Treatment

Emergency Department Care

ED care for those with serum sickness includes cessation of therapy involving the suspected antigen and initiation of supportive and symptomatic therapy as described below.

Medication

The goal of therapy is to treat the clinical syndrome resulting from the effects of soluble circulating immune complexes that form under conditions of antigen excess. These immune complexes can originate from the administration of either heterologous antisera or drugs known to cause serum sickness.

Antihistamines

These agents are used for symptomatic treatment of pruritus and may prevent the deposition of immune complexes. Prophylactic antihistamines may decrease the incidence of serum sickness by negating the action of vasoactive amines and preventing the increased vascular permeability that they induce.


Diphenhydramine (Benadryl)

For symptomatic relief of symptoms caused by the release of histamine in allergic reactions.

Adult

Initial dose: 50-100 mg PO/IV/IM
Maintenance dose: 10-50 mg PO/IV/IM q6-8h; not to exceed 400 mg/d

Pediatric

12.5-25 mg PO tid/qid, 5 mg/kg/d or 150 mg/m2/d IV/IM divided tid/qid; not to exceed 300 mg/d

Potentiates effect of CNS depressants; alcohol in syrup form may interact with medications that can cause disulfiramlike reactions

Documented hypersensitivity; concurrent administration with MAOIs

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

Precautions

May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction

Antipyretics

Bed rest and mild analgesic-antipyretic therapy are often helpful in relieving fever, arthralgias, and myalgias associated with the syndrome.


Aspirin (Anacin, Bayer Aspirin, Bufferin, and Ecotrin)

Lowers elevated body temperature by causing peripheral vasodilatation, thereby enhancing dissipation of excess heat; also acts on the heat-regulating center of the hypothalamus to reduce fever.

Adult

325-650 mg PO q4-6h; not to exceed 4 g/d

Pediatric

10-15 mg/kg/dose PO q4-6h; not to exceed 60-80 mg/kg/d

Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with coadministration of anticoagulants; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses >2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs

Documented hypersensitivity; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; <16 y with flu (because of association with Reye syndrome)

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

May cause transient decrease in renal function and aggravate chronic kidney disease; avoid in severe anemia, blood coagulation defects, or anticoagulant use

Corticosteroids

These agents have both anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties and cause profound and varied metabolic effects. These agents modify the immune response to diverse stimuli.


Prednisone (Deltasone, Orasone, Sterapred)

Immunosuppressant for the treatment of autoimmune disorders.

Adult

0.05-2 mg/kg/d PO divided bid/qid; alternatively, up to 80 mg/d qd or divided bid/qid; taper over 2 wk as symptoms resolve

Pediatric

4-5 mg/m2/d PO; alternatively, 1-2 mg/kg PO divided bid/qid; taper over 2 wk as symptoms resolve

Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral, fungal, tubercular skin, or connective tissue infections; peptic ulcer disease; hepatic dysfunction; GI disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur

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. Benson E. Bupropion-induced hypersensitivity reactions. Med J Aust. Jun 18 2001;174(12):650-1. [Medline].

  2. Wooltorton E. Bupropion (Zyban, Wellbutrin SR): reports of deaths, seizures, serum sickness. CMAJ. Jan 8 2002;166(1):68. [Medline].

  3. Gamarra RM, McGraw SD, Drelichman VS, Maas LC. Serum sickness-like reactions in patients receiving intravenous infliximab. J Emerg Med. Jan 2006;30(1):41-4. [Medline].

  4. 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].

  5. Lazoglu AH, Boglioli LR, Taff ML, Rosenbluth M, Macris NT. Serum sickness reaction following multiple insect stings. Ann Allergy Asthma Immunol. Dec 1995;75(6 Pt 1):522-4. [Medline].

  6. Berman BA, Ross RN. Acute serum sickness. Cutis. Nov 1983;32(5):420, 422. [Medline].

  7. Bigby M, Stern RS, Arndt KA. Allergic cutaneous reactions to drugs. Prim Care. Sep 1989;16(3):713-27. [Medline].

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

  9. Hart FD. Drug-induced arthritis and arthralgia. Drugs. Oct 1984;28(4):347-54. [Medline].

  10. Heckbert SR, Stryker WS, Coltin KL, Manson JE, Platt R. Serum sickness in children after antibiotic exposure: estimates of occurrence and morbidity in a health maintenance organization population. Am J Epidemiol. Aug 1990;132(2):336-42. [Medline].

  11. Lawley TJ, Bielory L, Gascon P, Yancey KB, Young NS, Frank MM. Human serum sickness. Trans Assoc Am Physicians. 1984;97:49-55. [Medline].

  12. Naguwa SM, Nelson BL. Human serum sickness. Clin Rev Allergy. Feb 1985;3(1):117-26. [Medline].

  13. Parker CW. Allergic reactions in man. Pharmacol Rev. Mar 1982;34(1):85-104. [Medline].

  14. Platt R, Dreis MW, Kennedy DL, Kuritsky JN. Serum sickness-like reactions to amoxicillin, cefaclor, cephalexin, and trimethoprim-sulfamethoxazole. J Infect Dis. Aug 1988;158(2):474-7. [Medline].

  15. Reynolds JS. Serum sickness: an old problem with new implications. Ann Allergy. Jul 1966;24(7):337-44. [Medline].

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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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