II. Pathophysiology

  1. Type 3 Hypersensitivity Reaction (Immune Complex-Mediated Reaction)
    1. Small immune-complex tissue deposition
    2. Results in Nephritis, Arthritis, Vasculitis

III. History

  1. Diphtheria Antitoxin reaction in the early 1900s was the original defining condition
    1. Antitoxin had historically been harvested from horses who had been injected with Diphtheria toxin
    2. Similar reactions were seen with Scarlet Fever antitoxin
    3. Modern day Diphtheria antitoxin is no longer produced in horses and does not cause Serum Sickness
  2. Snake Antivenom
    1. Older Snake Antivenoms were also harvested from horses and resulted in frequent reactions
    2. Newer Snake Antivenoms (e.g. CroFab) are now produced in sheep and associated with less common reactions

IV. Symptoms

  1. Onset of symptoms 4-21 days after exposure (mean 8-10 days)
  2. High Fever spikes
  3. Pruritic rash (including Urticaria)
    1. No mucous membrane involvement
    2. Rash starts in region of original injection
  4. Lymphadenopathy
  5. Polyarthralgias

V. Causes

  1. Equine-based microbial antitoxins (anti-Rabies, anti-botulinum, and anti-diphtheria Immunoglobulin)
  2. Antivenoms (Snake Antivenom, Anti-Lactrodectus Spider venom)
  3. Rabies Vaccine
  4. Stretokinase
  5. Insect Bite proteins
  6. Monoclonal Antibodies (e.g. Rituximab, Infliximab)

VII. Labs

  1. Complete Blood Count (CBC)
    1. Neutropenia
    2. Reactive Lymphocytes
    3. Mild Thrombocytopenia
  2. Comprehensive Metabolic Panel
    1. Transient Serum Creatinine increase may occur
  3. Acute Phase Reactant elevations
    1. Erythrocyte Sedimentation Rate
    2. C-Reactive Protein
  4. Urinalysis
    1. Mild Proteinuria

VIII. Management

  1. Withdraw causative agent
  2. Symptomatic management
    1. NSAIDs
    2. Corticosteroids in severe cases

X. References

  1. Rixe (2020) Serum Sickness, Stat Pearls, accessed 9/27/2020
    1. https://www.ncbi.nlm.nih.gov/books/NBK538312/
  2. Wener in Adkinson (2020) Serum Sickness and Serum Sickness-like Reactions, UpToDate, accessed 9/27/2020

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Serum Sickness (C0036830)

Definition (NCI) Delayed-type hypersensitivity reaction to foreign proteins derived from an animal serum. It occurs approximately six to twenty one days following the administration of the foreign antigen. Symptoms include fever, arthralgias, myalgias, skin eruptions, lymphadenopathy, chest pain, and dyspnea. Certain drugs (e.g., antibiotics, anticancer agents, and anti-inflammatory medications) and infectious disorders (e.g., hepatitis B) may also cause serum sickness-like reaction.
Definition (NCI_CTCAE) A disorder characterized by a delayed-type hypersensitivity reaction to foreign proteins derived from an animal serum. It occurs approximately six to twenty-one days following the administration of the foreign antigen. Symptoms include fever, arthralgias, myalgias, skin eruptions, lymphadenopathy, chest marked discomfort and dyspnea.
Definition (MSH) Immune complex disease caused by the administration of foreign serum or serum proteins and characterized by fever, lymphadenopathy, arthralgia, and urticaria. When they are complexed to protein carriers, some drugs can also cause serum sickness when they act as haptens inducing antibody responses.
Definition (CSP) immune complex disease caused by the administration of foreign serum or serum proteins and characterized by fever, lymphadenopathy, arthralgia, and urticaria; when they are complexed to protein carriers, some drugs can also cause serum sickness when they act as haptens inducing antibody responses.
Concepts Disease or Syndrome (T047)
MSH D012713
ICD10 T80.6
SnomedCT 72284000, 213324007, 213322006, 213323001, 213325008
English Serum Sicknesses, Sickness, Serum, Sicknesses, Serum, SERUM SICKNESS, serum reaction (diagnosis), serum sickness (diagnosis), serum intoxication, serum rash, serum reaction, serum intoxication (diagnosis), serum rash (diagnosis), serum sickness, urticaria due to serum (diagnosis), protein sickness, urticaria due to serum, protein sickness (diagnosis), Serum urticaria, Serum Sickness [Disease/Finding], Serum Sickness, Serum sickness (disorder), Protein sickness, Serum sickness, Intoxication by serum, Serum rash, Serum reaction, Transfusion reaction due to serum protein reaction, Urticaria due to serum, Serum rash (disorder), Transfusion reaction due to serum protein reaction (disorder), Urticaria due to serum (disorder), intoxication; serum, protein; sickness, rash; serum, reaction; serum, serum; intoxication, serum; rash, serum; reaction, serum; urticaria, urticaria; serum, Transfusion reaction due to serum protein reaction, NOS
French MALADIE SERIQUE, Séroréaction, Maladie sérique, Maladie du sérum
Portuguese DOENCA DO SORO, Reacção sérica, Doença do soro, Doença do Soro
Spanish ENFERMEDAD DEL SUERO, Reacción del suero, rash del suero, sarpullido del suero, salpullido del suero, enfermedad del suero (trastorno), enfermedad del suero, erupción sérica, intoxicación por suero, rash sérico (trastorno), rash sérico, reacción a una transfusión por reacción de las proteínas del suero (trastorno), reacción a una transfusión por reacción de las proteínas del suero, reacción del suero, urticaria por suero (trastorno), urticaria por suero, urticaria secundaria al suero, Enfermedad del suero, Enfermedad del Suero
German SERUMKRANKHEIT, Serumreaktion, Serumkrankheit
Italian Malattia da siero, Reazione da siero
Dutch serumreactie, exantheem; serum, intoxicatie; serum, proteïne; aandoening, reactie; serum, serum; exantheem, serum; intoxicatie, serum; reactie, serum; urticaria, urticaria; serum, serumziekte, Serumziekte, Ziekte, serum-
Japanese 血清病, 血清反応, ケッセイビョウ, ケッセイハンノウ
Swedish Serumsjuka
Czech sérová nemoc, Sérová reakce, Sérová nemoc
Finnish Seerumitauti
Russian SYVOROTOCHNAIA BOLEZN', СЫВОРОТОЧНАЯ БОЛЕЗНЬ
Polish Choroba posurowicza
Hungarian Szérumreakció, Szérumbetegség
Norwegian Serumsykdom, Serumsyke