Pediatric Serum Sickness Treatment & Management

Updated: Jul 17, 2018
  • Author: Tova Ronis, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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Treatment

Approach Considerations

The primary therapy in patients with serum sickness is discontinuation of the offending agent. Therefore, the identification of the offending agent is of the utmost importance. Although the use of heterologous protein, such as antithymocyte globulin (ATG), is easily identified, other more common medications, may not be as obvious. Follow-up care is needed until symptoms resolve.

Treatment also includes:

  • Supportive care

  • Antihistamines - For urticaria

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) - For arthritis, arthralgia, or both (but be cautious if renal involvement is present)

  • Steroids - Particularly if heterologous antiserum is necessary for management of the underlying condition

 

 

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Experimental Treatment

Tanriover et al investigated the therapeutic effects of plasma exchange as an alternative treatment for patients who developed severe serum sickness that was unresponsive to systemic steroids after receiving a polyclonal antibody (ATG [thymoglobulin] or lymphocyte immune globulin/antithymocyte globulin [Atgam]) for renal transplantation. [49] Five renal transplantation patients with serum sickness experienced complete resolution of all symptoms after receiving 1 or 2 courses of therapeutic plasma exchange.

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Medical Care

If the cause of serum sickness is clear and the patient is stable, inpatient care is unnecessary. However, in cases in which the etiology of the constitutional symptoms is uncertain or symptoms are worsening, further inpatient evaluation and management may be indicated.

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Consultations

In patients whose symptoms do not follow the typical course of spontaneous resolution consultation with an allergist/immunologist to rule out an immunoglobulin E (IgE)–mediated reaction may be helpful. Rheumatology consultation can evaluate for other causes of arthritis or vasculitis. Infectious disease specialists can help choose alternative antibiotic therapy.

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Activity

No restriction of activity is necessary, although arthritis, arthralgia, or both may limit the child's activity for several days to weeks.

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Prevention

The patient and family should be instructed to avoid using the offending agent in the future as well as drugs in the same class as the offending agent.

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