Unlike immediate allergic reactions, symptoms of serum sickness occur with a time delay. If necessary, symptoms should be treated medically.
What is serum sickness?
Serum sickness is a delayed hypersensitivity reaction of the body’s immune system. In serum sickness, this immune reaction is directed primarily against foreign proteins (proteins) that enter the body through the bloodstream (primarily with the help of injections or syringes). In most cases, serum sickness occurs only after repeated confrontation of the body with a corresponding protein. More rarely, however, the delayed immune reaction can occur even after a single administration of protein. Hypersensitivity reactions in the context of serum sickness are called delayed because symptoms usually appear only about 7-14 days after confrontation of the organism with a protein. Typical symptoms that may accompany serum sickness include, for example, joint pain, rashes, swelling of the lymph nodes, pain in the joints, and sudden fever.
Causes
Substances that can cause serum sickness in humans include antisera and vaccine sera. Antisera and vaccine sera, as possible causes of serum sickness, are processed antibodies (proteins produced by the immune system) obtained from the blood of humans or mammals. In particular, antisera are substances used to combat poisoning. Vaccine sera, on the other hand, are used for the purpose of so-called passive vaccination (the administration of special antibodies). If the body reacts to the administration of corresponding proteins with an undesired formation of antibodies, serum sickness occurs:
The body’s own immune reactions cause continuous changes in vessels and/or other body structures, which finally manifest themselves after a few days in symptoms typical of the disease.
Symptoms, complaints, and signs
Serum sickness presents with a variety of symptoms that usually appear within a few days. Dermatologic symptoms may occur earlier after injection of foreign proteins. On average, symptoms appear between the sixth and eleventh day after injection. In extreme cases, more than a month elapses before symptoms develop. Redness, swelling, itching and swelling of the lymph nodes may occur at the injection site. These symptoms may be accompanied by pain. Fever and general signs of illness usually occur. Joint pain and swollen lymph nodes occur. The circulation may be weakened and a drop in blood pressure follows. In extreme cases, serum sickness can lead to shock. Furthermore, inflammation of various parts of the body may occur. Thus, the development of meningitis is possible. Inflammation may also affect the kidneys or the small intestine. Furthermore, inflammation of the serous membranes can occur. These sheathe the internal organs and may become structurally weakened by inflammatory symptoms and cause pain. Most symptoms may resolve on their own within a few days. Not all sufferers of serous disease develop many or dangerous symptoms.
Diagnosis and course
A physician’s suspicion of the presence of serum sickness is often based initially on characteristic symptoms of an affected individual. The attending physician then usually obtains further diagnostic clues during a patient interview (here, for example, the affected person reports the onset of corresponding complaints and his or her medical history). Often, the next step is to check or rule out other diseases that show similar symptoms to those of serum sickness; these include, above all, measles and scarlet fever (infectious diseases caused by viruses and bacteria, respectively). The course of serum sickness depends, among other things, on the individually pronounced symptoms. In most cases, the symptoms associated with serum sickness subside on their own after a few days. If there is no renewed confrontation of the organism with the disease-causing sera, renewed symptoms usually do not occur.
Complications
Usually, serum sickness heals on its own within 14 days. Complications rarely occur.However, the severity of the immune reaction depends on the type and amount of antigen used. Usually, only fever, swelling of the lymph nodes and skin itching occur in the period of 4 to 21 days after contact with the antigen such as serum, insect bite or drug. In rarer cases, however, complications such as meningitis, inflammation of the kidneys (nephritis) or intestinal inflammation (enteritis) are possible. These are not caused by bacteria, but occur in the context of immune reactions. Their course depends on the severity of the immunological processes. In particularly severe cases, a life-threatening circulatory shock can occur. When circulatory shock occurs, urgent emergency medical assistance is required to end the life-threatening condition. During shock, blood pressure drops very sharply. In addition, cold sweat, cyanosis and thirst sensation occur. This results in an undersupply of oxygen to the body and especially to the brain. Sudden kidney failure may also occur. The main focus in the treatment of shock must be on stabilizing the blood pressure. In the vast majority of cases, however, treatment of serum sickness is not necessary because the symptoms disappear on their own. However, immunosuppressants such as corticosteroids must be given in particularly severe cases of disease.
When should you see a doctor?
If joint pain, rash, or fever symptoms occur, serum sickness may be underlying. Medical advice is needed if the typical signs of illness occur and do not resolve on their own. If the blood pressure drops rapidly, it is best to consult the doctor immediately. Shock reactions and swelling of the lymph nodes are also typical warning signs that require clarification. Serum sickness occurs in conjunction with an immune response. If symptoms occur after taking certain medications containing cefaclor, amoxicillin, or sulfonamides, the appropriate physician must be informed. People with immunodeficiency or chronic diseases are among the risk groups. Elderly people, children and pregnant women should also consult the doctor if unusual fever symptoms or pain occur that affect well-being. In addition to the family doctor, an internist or immunologist can be consulted. Other contacts are the emergency medical services or, in the case of intense symptoms, the emergency physician. Children are best presented to the pediatrician or taken directly to the nearest hospital.
Treatment and therapy
Because symptoms of serum sickness usually resolve on their own, medical treatment is not necessary in many cases. However, if corresponding symptoms cause a high degree of suffering in the patient and alternative causes of occurring symptoms could be excluded diagnostically, treatment steps can be used that have a palliative effect. Antihistamines or corticosteroids, for example, are used to treat the symptoms of serum sickness. Corticosteroids include cortisone, which is capable of influencing immune system processes and thus inhibiting the body’s own hypersensitivity reactions in the context of serum sickness. So-called antihistamines, for example, weaken the body’s own formation and/or the effectiveness of histamines in combating the symptoms of serum sickness – histamines, in turn, are involved in the development of inflammatory reactions. As a result, antihistamines can slow down inflammatory processes and associated symptoms in the context of serum sickness. In very severe cases of serum sickness, so-called plasmapheresis may also be necessary in rare cases. This involves an exchange of the blood plasma of an affected patient; the body’s own blood plasma is replaced by plasma concentrates from healthy plasma donors, for example.
Prevention
If a person is aware of which sera cause serum sickness in him or her, avoiding injecting the corresponding substances usually prevents an outbreak of the disease. For example, because serum sickness usually occurs only in response to sera foreign to the species, symptoms of the disease can often be prevented by using only human (species-specific or human) serum preparations when therapy or vaccination is needed.
Follow-up
Affected individuals should take care in their daily lives to support their immune systems on a daily basis.This includes a healthy and balanced diet and sufficient exercise. In addition, good sleep hygiene is important. The body’s immune system can be strengthened by eating a diet rich in vitamins while avoiding alcohol and nicotine. Regular ventilation is recommended when staying in closed rooms. It is also very important to spend time outdoors – preferably for several hours a day. In this way the organism can absorb the necessary oxygen. Sporting activities also help to strengthen the body. It is essential for recovery to avoid emotional stress and physical overload. Everyday life should be optimized so that phases characterized by hectic activity as well as physical exertion are reduced to a minimum. At the first signs of impairment, a break should be taken. If the person affected cannot achieve a cure with these measures, it is nevertheless possible to strengthen his general well-being and thus do something to improve his quality of life. The daily and nightly rhythms must be adapted to the individual needs of the body. Continuous daily routines are able to provide relief from existing complaints. At the first signs of inflammation or deterioration of health, consultation with a doctor seems essential.
This is what you can do yourself
In everyday life, the affected person should make sure that he supports his immune system on a daily basis. This can be done through a healthy and balanced diet, adequate exercise and good sleep hygiene. The body’s own defense system is strengthened as soon as the affected person eats a diet rich in vitamins and in parallel refrains from consuming harmful substances such as alcohol and nicotine. When staying in closed rooms, these should be ventilated regularly. Spending time outdoors should be done for several hours a day, so that the organism can absorb enough oxygen. Sports activities also help to strengthen the body. Emotional stress and physical overload should be avoided. Everyday life should be optimized so that phases of intense hectic or physical exertion are reduced. As soon as there are first signs of impairment, sufficient rest is necessary and a break should be taken. Although the affected person cannot achieve a cure with the measures of self-help, he can nevertheless use them to strengthen a general sense of well-being and thus contribute a great deal to improving his quality of life. The rhythms of day and night must be adapted to the needs of the body. Regular daily routines help to achieve relief from existing complaints. In case of initial inflammation or deterioration of health, cooperation with a doctor is essential.
