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

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.

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.

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.

Activity

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

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.

Medication

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Media Gallery

Urticarial rash in a child 10 days after cefaclor was administered for sore throat. Associated findings included fever, arthralgia of knees and ankles, and eosinophilia.

of 1

Author

Tova Ronis, MD Attending Rheumatologist, Division of Rheumatology, Children's National Medical Center; Clinical Assistant Professor of Pediatrics, George Washington University Medical Center

Tova Ronis, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Rheumatology, Childhood Arthritis and Rheumatology Research Alliance

Disclosure: Nothing to disclose.

Coauthor(s)

Hanna Kim, MD, MS Pediatric Rheumatology Fellow, AI Dupont Hospital for Children, Thomas Jefferson University, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Hanna Kim, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American College of Rheumatology, American Medical Association, Childhood Arthritis and Rheumatology Research Alliance, Rheumatism Society of the District of Columbia

Disclosure: Nothing to disclose.

Philip J Cohen, MD Chief, Section of Dermatology, New Jersey Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Lawrence K Jung, MD Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD Faculty, Division of Allergy/Immunology and Infectious Diseases, Department of Pediatrics, Saint Peter's University Hospital

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Pediatric Research, Society for Mucosal Immunology

Disclosure: Nothing to disclose.

Acknowledgements

Robyn Siperstein, MD Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Robyn Siperstein, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for MOHS Surgery, and Sigma Xi

Disclosure: Nothing to disclose.

David J Valacer, MD Consulting Staff, Hoffman La Roche Pharmaceuticals

David J Valacer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American Thoracic Society, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.