Serum sickness is a condition of the body, which is one of the forms of an allergic reaction. It develops in some people after the introduction into the body parenterally (injectively) a certain type of drugs - immune sera of animal origin - with a therapeutic or prophylactic purpose.
Causes of serum sickness
Often serum sickness develops in the case of the introduction of heterologous sera. These are biological preparations obtained from the blood of animals immunized with some kind of antigens, and containing the produced corresponding antibodies corresponding to these antigens. Similar drugs are used against dangerous infectious and toxic diseases: tetanus, botulism, diphtheria, gas gangrene, encephalitis, leptospirosis, anthrax, etc. Also used are serum preparations against the bites of poisonous snakes.
More rarely, the reaction is provoked by blood or plasma transfusions, insulin and liver extracts, antibiotics (penicillin, streptomycin, sulfanilamides, cephalosporins, etc.) and even insect bites (mostly Hymenoptera). The risk of developing pathology increases if there were earlier reactions to the introduction of serum drugs, and if there is an increased sensitivity to the epidermal proteins of animals. With intravenous development of serum sickness is observed more often than with intramuscular.
Serum sickness is a mechanism of development
Since serum sickness is an allergic reaction, immune mechanisms are involved in its development. When drugs with a foreign protein are introduced, antibodies that participate in the formation of immune complexes are produced. With prolonged circulation in the body, these complexes are deposited on the walls of capillaries of various tissues (lymph nodes, skin, kidneys, heart, etc.), causing the production and inflow of protective elements - leukocytes, histamine, serotonin, etc. As a result, vascular permeability increases, tissues.
Serum sickness - symptoms
By the duration of the flow, acute serum sickness, subacute and prolonged. If serum is introduced for the first time, the pathology develops approximately on the seventh day, but sometimes the incubation period is prolonged to 12-20 days. In cases where the protein preparation is used repeatedly, the latent phase of the disease is reduced to 1-6 days. The disease can occur in mild, moderate and severe forms.
Characteristic manifestations of pathology are:
- redness of the skin;
- skin rash, first arising at the injection site and spreading throughout the body (similar in appearance to urticaria , less often scarlet fever, erythematous);
- a skin itch of different intensity, often corresponding to the severity of the disease;
- fever, fever;
- weakness;
- headache;
- enlarged lymph nodes;
- muscle pain;
- intermittent pain in the joints;
- pain in the abdomen and kidneys;
- indigestion;
- puffiness (especially at the injection site, on the eyelids, lips, extremities);
- cardiopalmus;
- dyspnea;
- lowering of blood pressure;
- convulsions .
Serum sickness - diagnosis
To establish an accurate diagnosis of "serum sickness", differential diagnosis should be carried out by collecting anamnesis (which preceded the development of pathology), laboratory and histological studies that yield reliable results. According to the signs, the disease can resemble nodular periarteritis, acute rheumatic fever, measles, scarlet fever and some other infectious diseases, from which serum sickness should be distinguished. Occasionally, ultrasound and radiology are performed.
The following research data that support the diagnosis are taken into account:
- decrease or increase in the number of leukocytes;
- eosinophilia ;
- increase in erythrocyte sedimentation rate;
- increase in the content of cryoglobulins in the blood;
- the presence of protein and erythrocytes in the urine;
- the presence of plasma cells in the blood smear;
- inflammation of the vessels, detectable with a skin biopsy, etc.
Serum sickness - treatment
When confirming the diagnosis of "serum sickness", the symptoms and treatment are inextricably linked: depending on the form of manifestation and the severity of the processes, a treatment regimen is prescribed. Patients with mild disease, without complications, can be treated on an outpatient basis. Hospitalization is necessary in severe cases, in the presence of a lesion of the heart and nervous system, the presence of serious accompanying pathologies, unclear diagnosis, childhood and old age.
Serum sickness is an emergency
If anaphylactic shock occurs, serum sickness is subject to urgent treatment, because a threat to life is created. In this case, the clinical picture is characterized by a violent, very severe course: there is a sharp weakness, difficulty breathing, a strong drop in blood pressure, loss of consciousness. It is necessary urgently to call an ambulance or to deliver the patient to the nearest medical institution, where he will be injected with adrenaline. Before the arrival of physicians, it is required:
- Lay the patient on a flat surface, lifting his legs and turning his head to one side.
- Provide fresh air.
- Apply the tourniquet above the injection site and apply cold to this area.
- In the absence of breathing and pulse, conduct an indirect cardiac massage, artificial respiration.
Serum disease - clinical recommendations
In mild cases, serum sickness passes by itself for several days, even without treatment. To ease the condition and speedy recovery, the following groups of drugs are prescribed:
- antipruritic local remedies (eg, based on menthol);
- antihistamines (Suprastin, Tavegil, Dimedrol);
- preparations of calcium;
- drugs to strengthen the vascular walls (Ascorutin).
In more severe cases, in addition to the above, serum sickness drugs for treatment include the following:
- corticosteroids (Prednisolone, Hydrocortisone
- non-steroidal anti-inflammatory drugs (Ketoprofen, Ibuprofen, Analgin);
- diuretics (Lasix, Furosemide), etc.
Serum sickness - complications
Syndrome of serum sickness, in addition to anaphylaxis, can be complicated by other diseases that often occur with prolonged absence of therapy. We list the possible complications:
- neuritis;
- myocarditis;
- synovitis;
- diffuse involvement of connective tissue;
- glomerulonephritis;
- hepatitis;
- necrosis of the skin and subcutaneous tissue in the injection zone.
Serum sickness - prevention
The main measures in accordance with which the prevention of serum sickness is carried out are:
- use of preparations with a high degree of purification;
- the introduction of sera of animal origin according to strict indications, if possible replacing them with human gamma globulin;
- observance of special care when introducing serums to people who have already experienced allergic reactions;
- carrying out skin tests before injections;
- the introduction of diluted sera or the use of specific schemes for the injection.