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The serum sickness syndrome is a characteristic systemic immunologic disorder that follows the administration of a foreign material or medication.
Serum sickness is the classic example of a type III hypersensitivity, "immune complex" disease. Antigen-antibody complexes formed under conditions of moderate antigen excess lodge in small vessels and in filtering organs throughout the body (deposition being aided in the rabbit by the actions of immunoglobulin [Ig] E antibody, basophils, and platelet-activating factor and by the release of vasoactive amines that increase the permeability of blood vessels); these complexes activate.
Typically, the symptoms of serum sickness begin 7-12 days following injection of the foreign material but may appear as late as 3 wk afterward. If there has been earlier exposure or previous allergic reaction to the same foreign antigen, symptoms may appear in accelerated fashion, within 1-3 days following injection, or as anaphylaxis. Fever and malaise are almost always present, as are cutaneous eruptions. Urticaria, usually generalized, is a common finding. Faint erythema with a serpiginous border.
The blood leukocyte and eosinophil counts are variable; marked thrombocytopenia is often found. Mild proteinuria, hemoglobinuria, and microscopic hematuria may be seen. Plasma cells have been found in blood. The erythrocyte sedimentation rate is often increased. A sheep cell agglutinin titer.
Patients generally respond well to aspirin and antihistamines.
High doses are given and rapidly reduced.
The use of horse serum or other animal serum in therapy should be limited to cases for which no alternative is available. When only equine antitoxin is available, skin tests should be employed prior to administration of serum, beginning with a puncture test using a 1:10 dilution. If the reaction is negative.