Serum Sickness

What is serum sickness?

Serum sickness is your immune system’s response to a medication. The medicines cause hypersensitivity.

Serum sickness takes time to develop. It may take up to three weeks after your first exposure to a medicine. After the first exposure, you may develop symptoms just a few days after another exposure.

What is the mechanism of serum sickness?

Healthcare providers classify immune reactions to a foreign substance (antigen) as hypersensitivity reactions. There are four types of hypersensitivity reactions. Serum sickness is type 3.

• Type 1. A type 1 hypersensitivity reaction is an immediate reaction that involves immunoglobulin E (IgE). IgE are antibodies that your immune system makes. They target specific types of allergens and attach to cells that contain histamine (mast cells). When IgE encounters the allergen, it causes the mast cells to release the histamine and other inflammatory mediators. Examples include a severe allergic reaction (anaphylaxis) and hay fever (allergic rhinitis).
• Type 2. A type 2 hypersensitivity reaction involves immunoglobulin G (IgG) or immunoglobulin M (IgM). IgG is the most common antibody and protects your body from infections. IgM is an antibody in your blood and lymph node fluid. It’s the first type of antibody your body makes to combat a new infection. An example is drug-induced hemolytic anemia.
• Type 3. IgM or IgG antibodies attach to the antigen to form an immune complex. The immune complex attaches to tissues or the walls of your blood vessels. You may have a localized reaction (symptoms around or that extend slightly beyond where you got a sting, bite or injection) or a systemic reaction (symptoms that spread to other organ systems in your body). Serum sickness is an example of a systemic type 3 reaction.
• Type 4. T lymphocytes (T-cells) cause type 4 hypersensitivity reactions, not antibodies. T-cells are a type of white blood cell. Examples include contact dermatitis from nickel or poison ivy.

What are the symptoms of serum sickness?

Serum sickness symptoms may include:

• General feeling of illness, discomfort or fatigue (malaise).
• Skin rash.
• Hives.
• Itchy skin.
• Fever.
• Joint pain.
• Swollen lymph nodes.

What causes serum sickness?

Causes of serum sickness reactions may include:

• Antibiotics, including penicillin, sulfonamides and tetracyclines.
• Antivenoms (antivenins).
• Barbiturates.
• Buproprion.
• Medicines that contain proteins from animals or insects.
• Monoclonal antibodies.
• Stings or bites from bees, wasps, mosquitos and ticks.
• Streptokinase (a medicine that breaks up blood clots).
• Vaccines.

Many other antibiotics and other medications may cause serum sickness. Talk to a healthcare provider to get a complete list.

What is the most common cause of serum sickness today?

The most common causes of serum sickness reactions include:

• Antibiotics.
• Antitoxins.
• Antivenoms.
• Vaccines.
• Streptokinase.

Can adults get serum sickness?

Yes. Anyone can get serum sickness, including adults.

What are the complications of serum sickness?

Serum sickness complications may include:

• Kidney
• Inflammation in your blood vessels (vasculitis).
• Nerve damage (neuropathy).
• A sudden drop in blood pressure in your body (shock).

Very rarely, serum sickness can cause glomerulonephritis (GN). GN is a type of kidney disease that damages the tiny blood vessels in your kidneys (glomeruli) that help filter your blood.

How do you know if you have serum sickness?

You may have serum sickness if you develop allergy-like symptoms several days or weeks after taking a medicine. A healthcare provider can make an official diagnosis. They’ll:

• Ask about your medical history.
• Ask if you’re taking any medications, including whether you’ve taken any medications or received any medications over the last several weeks.
• Perform a physical examination, including checking your lymph nodes for swelling or tenderness.

They’ll also order tests to confirm serum sickness.

What tests will be done to diagnose serum sickness?

Healthcare providers usually diagnose serum sickness after reviewing your symptoms and performing a physical exam. But they may order the following tests to confirm the diagnosis and determine its severity:

• Blood test. They’ll use a tiny needle to withdraw a small amount of blood from a vein, usually in your arm, and study it in a lab.
• Skin biopsy. They’ll remove a small sample of your skin tissue and examine it in a lab. They’ll look for inflammation in your blood vessels along with different types of immunoglobulin.
• Urinalysis. You’ll urinate (pee) into a cup and they’ll examine your sample under a microscope. Your kidneys make pee and serum sickness can affect your kidneys. They’ll look for signs of kidney damage in your pee.

Is serum sickness curable?

Yes, serum sickness is curable. Symptoms usually go away on their own after a few days. But treatment may include the following:

• Stopping the medicine that causes serum sickness, if possible.
• Corticosteroids.
• Antihistamines.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).

How do you recover from serum sickness?

Following your healthcare provider’s recommended treatment is the best way to recover from serum sickness. Most people feel better a few days after symptoms start.

Can serum sickness be prevented?

The best way to prevent serum sickness is to avoid medicines that cause symptoms.

What can I expect if I have serum sickness?

The outlook for serum sickness is good. Many people make a full recovery without treatment after a few days. But regular or long-term exposure to the medicine that causes serum sickness can cause serious problems, including kidney damage and even kidney failure.

What are the long-term effects of serum sickness?

Serum sickness usually doesn’t have long-term effects. Be sure to avoid any medicines that cause serum sickness to prevent kidney failure.

When should I see a healthcare provider?

It’s a good idea to talk to a healthcare provider if you take a medicine or antiserum (plasma) and develop symptoms of serum sickness a few weeks later. They’ll conduct tests and, if necessary, give you a new medicine that doesn’t cause serum sickness.

What questions should I ask a healthcare provider?

Questions to consider asking your provider include:

• How do you know I have serum sickness?
• If I don’t have serum sickness, what other condition might I have?
• What medicine caused serum sickness?
• Is there an alternative medicine I can take that doesn’t cause serum sickness?
• Did serum sickness damage my kidneys?

What is the difference between Arthus reaction and serum sickness?

An Arthus reaction is also a type 3 hypersensitivity reaction that may develop after a vaccine or, rarely, repeated insect bites. It’s a localized reaction that develops much faster than serum sickness — usually less than 24 hours.

A note from Cleveland Clinic

Serum sickness is a delayed immune response that usually occurs due to medications. Symptoms are typically mild.

Serum sickness can be frustrating if you don’t know what’s causing your immune system to overreact. And because it takes so long for symptoms to develop, you may not make the connection that your symptoms relate to a medicine you took several weeks earlier. You should talk to a healthcare provider if you develop serum sickness symptoms. They can conduct tests to pinpoint the cause of your serum sickness and prescribe medications to help relieve your symptoms. And, if possible, they’ll recommend a different medication that doesn’t cause serum sickness.