Serum sickness

Serum sickness is a systemic immunopathological reaction to the introduction of parenteral foreign protein, serum of animals. It can appear both with repeated, and primary introduction of foreign serum. Serum sickness occurs in 5-10% of patients who were injected with foreign serum.

Acquired in the body of the child, the foreign protein circulates in the blood, causes the synthesis of antibodies with the subsequent formation of immune complexes, their deposition on tissues with damage to the latter and the release of biologically active substances.

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Causes of serum sickness

Serum sickness can develop both with repeated, and with the initial introduction of foreign serum (against tetanus, diphtheria, rabies, snake bites, botulism or gas gangrene). Syndrome of serum sickness is sometimes noted after the introduction of y-globulin, antilymphocyte serum, insect bite.

[3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Pathogenesis

In the mechanism of development of serum sickness, the long-term circulation of foreign protein in the blood, the formation of secondary antigens and further immune complexes (with the obligatory participation of complement), the settling of circulating immune complexes on tissues with damage to them (the III type of hypersensitivity reactions, allergic reactions developing in type phenomenon of Artyus). The incubation period of the disease is 1-2 weeks. In other cases, when the characteristic clinical picture develops faster (in the first 1-5 days after the application of serum), the skin-sensitizing antibodies (reactive-IgE) play a major role in the pathogenesis and the allergic reaction proceeds as anaphylactic.

Symptoms of serum sickness

Symptoms of serum sickness are characterized by the appearance of soreness and swelling at the injection site of the serum on the 7th-10th day after its administration. The patient has fever, an increase in regional lymph nodes, sometimes joint damage (arthralgia, edema), on the skin appears a urticaria papular or erythematous itching rash; conjunctivitis. Symptoms from the cardiovascular system are noted: tachycardia, muffling of tones, expansion of the borders of the heart. Reduced blood pressure. The child of an early age may have a lesion of the gastrointestinal tract: vomiting occurs, the stool becomes frequent with mucus, "intestinal colic" occurs. In the urine may appear proteinuria, microhematuria. Sometimes, in severe serum disease, laryngeal edema may develop with the development of stenotic breathing, asphyxia, hemorrhagic syndrome. In mild forms, the disappearance of clinical symptoms may occur 2-5 days after the onset of serum sickness, in severe cases, after 2-3 weeks.

Prognostically unfavorable for full recovery: severe heart, kidney, nervous system, development of hemorrhagic syndrome, edema of the larynx.

Treatment of serum sickness

With an easy flow prescribe antihistamines, inside 10% calcium chloride solution or 10% calcium gluconate solution, prescribe ascorbic acid, routine. In severe cases, prednisolone is administered at a rate of 1 mg / kg of body weight per day in a short course. With a sharp itch - local rubbing 5% solution of menthol alcohol. With articular syndrome appoint intometatsii, brufen, voltaren.

Prevention of serum sickness

With the introduction of animal sera - diphtheria antitoxin, tetanus antitoxin, botulinum antitoxin, anti-rabies serum. The Committee on Pediatric Infections of the American Academy of Pediatrics recommends the following sequence of activities:

• on the inner surface of the forearm to make a scratch, prick or puncture, and from the top drop one drop of whey in a 1: 100 dilution in isotonic sodium chloride solution; positive reaction with erythema in diameter more than 3 mm is considered positive ("read" after 15-20 min);
• with a negative reaction to children without a burdened allergological anamnesis, 0.02 ml of serum in a dilution of 1: 100 is intradermally administered;
• children with atopic diathesis are first introduced a dilution of serum 1: 1000 and with a negative reaction after 20 minutes, a dilution of 1: 100 is introduced, wait 30 minutes;
• with a negative reaction, the whole dose of therapeutic serum is administered intramuscularly.

If intravenous administration is necessary (for example, in the toxic form of diphtheria), then 0.5 ml of serum diluted in 10 ml of isotonic sodium chloride solution is preliminarily administered and only after 30 minutes the remaining serum is diluted 1:20 (rate of administration 1 ml / min ). When introducing serums, you should always have an anti-shock medication kit.

Even an intradermal test, not to mention subcutaneous and intravenous administration, can be complicated by anaphylactic shock. However, it is believed that the intravenous route of serum administration is safer because it is better controlled. Negative tests do not guarantee the absence of an anaphylactic shock when the whole dose is introduced, which necessitates the availability of an anti-shock medication kit when sera are administered.

Prognosis for serum sickness

The prognosis is usually favorable, if there is no kidney damage.