WordNet

defectiveness or unsoundness; "drugs have become a sickness they cannot cure"; "a great sickness of his judgment"
an amber, watery fluid, rich in proteins, that separates out when blood coagulates (同)blood_serum

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〈U〉『病気でいること』;〈C〉(個々の)『病気』 / 〈U〉吐き気(nausea)
リンパ液 / 血清
serial / series / sermon

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/22 06:51:40」(JST)

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Serum sickness in humans is a reaction to proteins in antiserum derived from a non-human animal source, occurring 4–10 days after exposure. It is a type of hypersensitivity, specifically immune complex hypersensitivity (type III). The term serum sickness-like reaction (SSLR) is occasionally used to refer to similar illnesses that arise from the introduction of certain non-protein substances.^[1] It was first characterized by Clemens von Pirquet and Béla Schick in 1906.^[2]

Causes

When an antiserum is given, the human immune system can mistake the proteins present for harmful antigens. The body produces antibodies, which combine with these proteins to form immune complexes. These complexes precipitate, enter the walls of blood vessels, and activate the complement cascade, initiating an inflammatory response and consuming much of the available complement component 3 (C3). The result is a leukocytoclastic vasculitis. This results in hypocomplementemia, a low C3 level in serum. They can also cause more reactions resulting in typical symptoms of serum sickness.

Antitoxins and antisera

Serum sickness can be developed as a result of exposure to antibodies derived from animals. These sera or antitoxins are generally administered to prevent or treat an infection or envenomation.

Drugs

Some of the drugs associated with serum sickness are:

allopurinol
barbiturates
captopril
cephalosporins
griseofulvin
penicillins
phenytoin
procainamide
quinidine
streptokinase
sulfonamides
rituximab
ibuprofen

Others

Allergenic extracts, hormones and vaccines can also cause serum sickness.

Symptoms

Symptoms can take as long as 14 days after exposure to appear, and may include signs and symptoms commonly associated with hypersensitivity or infections.

rashes
itching
joint pain (arthralgia), especially finger and toe joints
fever, as high as 104 °F and usually appears before rash
lymphadenopathy (swelling of lymph nodes), particularly near the site of injection, head and neck
malaise
hypotension (decreased blood pressure)
splenomegaly (enlarged spleen)
glomerulonephritis
proteinuria
hematuria
shock

Diagnosis

Diagnosis is based on history given by patient, including recent medications.

Treatment

With discontinuation of offending agent, symptoms usually disappear within 4–5 days.

Corticosteroids, antihistamines, and analgesics are the main line of treatment. The choice depends on the severity of the reaction.

Use of plasmapheresis has also been described.^[3]

Prevention

Avoidance of antitoxins that may cause serum sickness is the best way to prevent serum sickness. Although, sometimes, the benefits outweigh the risks in the case of a life-threatening bite or sting. Prophylactic antihistamines or corticosteroids may be used concomitant with the antitoxin. Skin testing may be done beforehand in order to identify individuals who may be at risk of a reaction. Physicians should make their patients aware of the drugs or antitoxins to which they are allergic if there is a reaction. The physician will then choose an alternate antitoxin if it's appropriate or continue with prophylactic measures.

References

^ Brucculeri M, Charlton M, Serur D (2006). "Serum sickness-like reaction associated with cefazolin". BMC Clin Pharmacol 6: 3. doi:10.1186/1472-6904-6-3. PMC 1397863. PMID 16504095.
^ Jackson R (October 2000). "Serum sickness". J Cutan Med Surg 4 (4): 223–5. PMID 11231202.
^ Lundquist AL, Chari RS, Wood JH, et al. (May 2007). "Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review". Liver Transpl. 13 (5): 647–50. doi:10.1002/lt.21098. PMID 17377915.

External links

Serum sickness-like reactions

UpToDate Contents

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1. 血清病および血清病様反応 serum sickness and serum sickness like reactions
2. 薬物アレルギー：分類および臨床的特徴 drug allergy classification and clinical features
3. ペニシリンアレルギー：遅発型過敏反応 penicillin allergy delayed hypersensitivity reactions
4. 頭部白癬 tinea capitis
5. 小児における過敏性血管炎 hypersensitivity vasculitis in children

English Journal

Demographic and clinical characteristics of patients with serum sickness-like reaction.

Yorulmaz A1, Akın F2, Sert A3, Ağır MA4, Yılmaz R4, Arslan Ş5.
Clinical rheumatology.Clin Rheumatol.2017 Aug 9. doi: 10.1007/s10067-017-3777-4. [Epub ahead of print]
PMID 28795234

Role of Antioxidants in Horse Serum-mediated Vasculitis in Swine: Potential Relevance to Early Treatment in Mitigation of Coronary Arteritis in Kawasaki Disease.

Philip S1, Lee WC2, Cherian KM3, Wu MH4, Lue HC4.
Pediatrics and neonatology.Pediatr Neonatol.2017 Aug;58(4):328-337. doi: 10.1016/j.pedneo.2016.07.007. Epub 2016 Dec 18.
PMID 28209472

Acetazolamide and N-acetylcysteine in the treatment of chronic mountain sickness (Monge's disease).

Sharma S1, Gralla J2, Ordonez JG3, Hurtado ME3, Swenson ER4, Schoene RB5, Kelly JP6, Callacondo D7, Rivard C1, Roncal-Jimenez C1, Sirota J8, Fuquay R9, Jackson BP10, Swenson KE11, Johnson RJ12, Hurtado A3, Escudero E3.
Respiratory physiology & neurobiology.Respir Physiol Neurobiol.2017 Jul 15;246:1-8. doi: 10.1016/j.resp.2017.07.005. [Epub ahead of print]
PMID 28720395

Japanese Journal

症例報告急性B型肝炎に伴う血清病様症候群の1例

佐伯葉子,安藤菜緒,岡島加代子 [他]
臨床皮膚科 67(12), 1007-1011, 2013-11
NAID 40019862699

腸管スピロヘータが原因と考えられた大腸炎の1例

杉田光司,片岡伸一,西岡伸明,楯英毅,上野圭介,奥井雅憲,西上隆之
日本消化器内視鏡学会雑誌 54(11), 3596-3600, 2012
腸管スピロヘータ症はグラム陰性のらせん状桿菌を原因とする人畜共通感染症である．その臨床像については臨床医・病理医の認知度は高いとは言えず，スピロヘータ感染のみで強い炎症像を呈することは少ないとされている．今回われわれは下痢を主訴とし内視鏡的に区域性の浮腫と発赤及び潰瘍形成を認めスピロヘータの単独感染と考えられる症例を経験したので報告する．
NAID 130002570686

rituximab により血清病を呈した造血器腫瘍の2症例

松井崇浩,日高道弘,河北敏郎 [他],井上佳子,榮達智,原田奈穂子,武本重毅,長倉祥一,塚本敦子,清川哲志,河野文夫
臨床血液 50(4), 304-308, 2009-04-30
NAID 10024959688

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★リンクテーブル★

リンク元	「血清病」
拡張検索	「serum sickness-like reaction」
関連記事	「sickness」

「血清病」

Serum sickness
Classification and external resources
Specialty	emergency medicine
ICD-10	T80.6
ICD-9-CM	999.5
DiseasesDB	11970
MedlinePlus	000820
eMedicine	med/2105
MeSH	D012713
	[edit on Wikidata]