A specific treatment plan is prepared by a specialist in the field of clinical allergology. In each case, it is individual, taking into account the severity of the course, the presence of complications, concomitant diseases, the age of the patient.
The basic principles of treatment include:
- Abolition of problematic drugs. The termination of the introduction of serum, penicillin preparations and other pharmacological agents that cause increased sensitivity of the body.
- The earliest possible removal of allergens. It is recommended to carry out infusion therapy, taking a large amount of fluid, cleansing enema, the appointment of laxatives and enterosorbents.
- Compliance with a hypoallergenic diet. A short-term hungry pause or fasting day is appointed, then meals are given with the exception of potential allergens.
- Acceptance of antihistamine drugs. With a mild course of serum sickness, drugs are administered orally, with moderate and severe form, parenteral.
- Glucocorticoid hormones. Reception is carried out in individually selected dose for 1-2 weeks by mouth or intramuscularly.
In case of anaphylactic shock, emergency care measures are carried out with the mandatory hospitalization of the patient in the hospital and follow-up for 3-5 days. Symptomatic therapy is prescribed in the presence of signs of damage to internal organs and joints. Non-steroidal anti-inflammatory drugs, anticoagulants, diuretics, sedatives, etc. are used.
Serum sickness refers to allergic diseases with an immunocomplex type of response, occurs in response to the introduction of foreign sera, certain protein fractions and certain drugs. In this case, the pathological process extends to various organs and tissues of the body, including the skin, kidneys, heart muscle, joints. Hypersensitivity to injected parenteral vaccines and sera occurs in about 1-2% of drug allergy cases. The disease was first described by the Austrian immunologist Pirke in 1902.
Causes of Serum Disease
The onset of the disease is associated with the parenteral introduction of foreign protein components and drugs into the body, leading to the development of a systemic allergic reaction.
The most common causative factors include:
- Alien serum proteins, vaccines. More often, these are heterogeneous (prepared from the blood of immunized animals), less commonly – homologous (from the serum of ill or immunized people) preparations. Allergic reactions can develop with the introduction of anti-diphtheria, tetanus, anti-gangrenous, anti-totulinic, anti-staphylococcal, anti-smear serum, anti-leptospirosis immunoglobulin and other drugs, occasionally with human immunoglobulins and monoclonal antibodies.
- Some medications : penicillin beta-lactam antibiotics, cephalosporins, sulfonamides (clotrimazole), cytostatics and some nonsteroidal anti-inflammatory drugs, separate preparations containing iodine and bromine.
Adverse factors that increase the likelihood of developing serum sickness and its complications include hereditary predisposition, including identification of immunological markers – DR-4, B-13HLA antigens.
The occurrence of concomitant diseases accompanied by secondary immunodeficiency, as well as the use of certain medications (for example, beta-blockers), make the course of an allergy more severe.
Pathogenesis of serum sickness
For serum sickness, an immunocomplex type of allergic reactions is characteristic. At the same time, in response to the first administration of a vaccine or serum, specific antibodies are synthesized in the body, which, upon repeated contact with the allergen, form circulating immune complexes, which are fixed on the inner wall of blood vessels.
In the future, the pathological process leads to activation of complement; its components (C3a, C4a and C5a) cause an increase in vascular permeability, attract neutrophils to circulating immune complexes, as a result of which an inflammatory process like systemic vasculitis develops. The most frequently observed lesions of the renal vessels (renal glomeruli with the development of glomerulonephritis), as well as the coronary and pulmonary arteries.
Symptoms of serum sickness
Clinical symptoms usually appear 7–20 days after the intravenous or intramuscular injection of a foreign protein that is part of a vaccine, serum, immunoglobulin, or drug. The body of sensitized persons reacts to re-introduction of the antigen in a shorter time – after a few hours or days. Symptoms of serum sickness are diverse and depend on the type of drug administered and its antigenic activity, the reactivity of the immune system, the presence of concomitant diseases and other factors.
The first signs of the disease can be noticed already on the 1-2 day after administration of the vaccine or drug, which is manifested by limited hyperemia (redness), swelling or itching at the injection site, the appearance of small rashes on the skin. 1-3 weeks after the introduction of a foreign protein, the general reaction of the body develops with hyperthermia up to 39-40 ° C, enlarged lymph nodes, skin changes like urticaria and angioedema, as well as scarlet-like, papular, less often hemorrhagic rash that can spread throughout the body.
The pathological process in serum sickness often extends to the middle and small joints of the upper and lower extremities (elbow and wrist, knee, ankle, as well as small joints of the hands and feet). At the same time, there is swelling and soreness, a decrease in the range of motion in the joints affected by the inflammatory process.
There is a violation of the function of the cardiovascular system (due to the development of vasculitis with a lesion of the coronary arteries), which is manifested by prolonged painful sensations behind the sternum and in the region of the heart, shortness of breath with little exertion, decreased blood pressure, tachycardia, and general weakness.
Damage to the endothelium of the kidney vessels by circulating immune complexes in the blood leads to the development of a chronic inflammatory process in the glomeruli – glomerulonephritis, which is characterized by a progressive course with the presence of secondary arterial hypertension, widespread edematous syndrome, renal failure.
Depending on the severity, there are several forms of the course of serum sickness. The mild form occurs in 50% of patients and is manifested by a minor impairment of general well-being with low-grade fever, localized rash, and an increase in regional lymph nodes. With moderate and severe form of a violation of the general condition (headaches, fever, lowering blood pressure, nausea and vomiting, diarrhea). At the same time, the skin of the whole body is affected, pains behind the sternum, in the joints and the lumbar region, shortness of breath, decrease and loss of efficiency, and the duration of the disease is from 1 to 3 weeks or more.
Complications of serum sickness include the development of anaphylactic shock in response to repeated intravenous administration of alien serum. Symptomatology is manifested by a sudden decrease in blood pressure and hyperthermia, the appearance of a convulsive syndrome, loss of consciousness, spontaneous urination and defecation.
In the absence of timely emergency care, the patient’s death often occurs.
Significantly aggravates the course of serum sickness and the appearance of signs of damage to internal organs with the development of myocarditis and endocarditis, exudative pericarditis, nephritis, encephalitis and meningitis, Guillain-Barré syndrome and other diseases.
Diagnosis of Serum Disease
The correct diagnosis is established as a result of analysis of anamnestic data, clinical examination and laboratory tests:
- Anamnesis. Includes the study of information about allergies suffered, the presence of a vaccine or serum injection shortly before the onset of allergy symptoms.
- Clinical examination. An allergist-immunologist doctor reveals the characteristic signs of serum sickness: local changes on the skin around the injection site, hyperthermia, symptoms of damage to internal organs, joints, etc. If necessary, consult a cardiologist, nephrologist, rheumatologist, infectious disease specialist.
- Laboratory studies. In the blood, they can detect signs of leukocytosis or leukopenia, relative lymphocytosis, neutropenia, sometimes – an increase in the number of eosinophils and plasma cells, a decrease in the number of platelets. In the serum is often determined by increasing the concentration of C-reactive protein, an increase in AlAT and AST. In the urine with the defeat of the glomeruli of the kidneys, proteinuria, microhematuria are detected, hyaline cylinders appear.
- Allergological studies. Most often, the concentration of circulating immune complexes, components of the complement is determined by enzyme immunoassay (ELISA) and immunodiffusion. Shelly’s basophilic test is performed, IgE antibodies to antibiotics of the penicillin series are determined, a lymphocyte transformation test and other studies are carried out.
Differential diagnosis of serum sickness is carried out with other allergic diseases, infections, skin diseases, rheumatism, glomerulonephritis.
Prognosis and prevention of serum sickness
With timely access to an allergist and adequate therapy, serum sickness in most cases ends in recovery within 1-3 weeks. With the development of severe complications (anaphylactic shock, renal failure, meningitis and encephalitis, endocarditis, etc.), the prognosis worsens.
Prevention is based on conducting awareness-raising work among the population, improving the quality of vaccines, sera, immunoglobulins, antibiotics, restricting the use of preparations based on horse serum, improving the equipment of medical institutions with diagnostic tools and providing emergency care for allergies.