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Serum sickness

Introduction:

Serum sickness describes a delayed immune system response, either to certain kinds of medications or to antiserum (given after a person has been bitten by a snake or to counter exposure to rabies, for example). Serum is the clear fluid part of blood. Serum sickness is similar to an allergy, in that the body mistakenly identifies a protein from the antiserum or medication as harmful and activates the immune system to fight it off. Today, the most common cause of serum sickness is the antibiotic penicillin. Serum sickness will usually develop within 7 - 10 days after initial exposure, but sometimes it can take as long as 3 weeks. If you are exposed again to the substance, serum sickness tends to develop faster (within 1 - 4 days), and only a very small amount of the substance may cause an intense response.



Signs and Symptoms:

The first signs of serum sickness are redness and itching at the injection site. Other signs and symptoms include:

  • Skin rash, hives
  • Joint pain
  • Fever
  • Malaise (feeling unwell)
  • Swollen lymph nodes
  • Itching
  • Wheezing
  • Flushing
  • Diarrhea, nausea, abdominal cramping


What Causes It?:

Antigens, proteins the body mistakenly identifies as harmful, cause your immune system to produce antibodies. These antibodies bind with the antigens and build up on the layers of cells that line the heart, blood vessels, lymph vessels, and other body cavities. This causes inflammation and other symptoms of serum sickness.

Penicillin is the most common cause of serum sickness. Other causes include:

  • Other antibiotics, including cephalosporins
  • Fluoxetine (Prozac) used for depression
  • Barbiturates
  • A class of diuretics called thiazides
  • Products that contain aspirin
  • Many other medications
  • Snake venom antiserum
  • Bee or wasp sting (rare)


Who's Most At Risk?:

You are more likely to suffer from serum sickness if:

  • You are injected with one of the drugs or antitoxin known to cause serum sickness.
  • You need a large amount of snake venom antiserum.
  • You have previously been exposed to a drug or antitoxin known to cause serum sickness.


What to Expect at Your Provider's Office:

Your doctor will look for typical symptoms and ask if you have been recently exposed to any antiserum. Your doctor may order blood and urine tests.



Treatment Options:

Prevention

  • If you know you are sensitive to a particular drug or antiserum, you should tell your health care provider before you get any kind of injection.
  • A health care provider can perform skin tests to check for serum sensitivity before giving antiserum.
  • If you are sensitive to an antiserum, your health care provider may use a method that desensitizes you to the antiserum, at least temporarily.

Drug Therapies

Treatment for serum sickness is aimed at reducing symptoms. Your doctor may prescribe antihistamines or analgesics (nonsteroidal anti-inflammatory drugs), along with topical medications to relieve itching or rash. In serious cases, your doctor may prescribe corticosteroids, such as prednisone. Normally, there is no need for hospitalization. Fever typically gets better within 48 - 72 hours of treatment.

Complementary and Alternative Therapies

If you suspect you have serum sickness, you should see a doctor immediately and receive conventional medical treatment. Some CAM therapies may support conventional treatment by helping to reduce inflammation and stabilize your immune system, but no scientific studies have been done on the effectiveness of CAM therapies for serum sickness. Although certain CAM therapies may help relieve symptoms, others could actually make them worse. Take any herb, supplement, or medication only under your doctor's supervision.

Nutrition and Supplements

The following nutrients may help support your immune system and reduce allergic reactions in general, though there is no scientific evidence that they will be effective for serum sickness and, as noted, some may make serum sickness worse. Talk to your doctor before taking any of these supplements.

Following these nutritional tips may help reduce risks and symptoms:

  • Eliminate all suspected food allergens, including dairy, wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
  • Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.
  • Use healthy oils for cooking, such as olive oil or vegetable oil.
  • Reduce significantly or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise moderately for 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

  • A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoonfuls oil daily, to help decrease inflammation and improve immunity. Omega-3 fatty acids can have a blood-thinning effect and can interact with other blood-thinning medications, such as warfarin (Coumadin) and aspirin.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity. Coenzyme Q-10 might help the blood clot. By helping the blood clot, coenzyme Q-10 might decrease the effectiveness of warfarin (Coumadin).
  • Vitamin C, 1 - 6 gm daily, as an antioxidant. Vitamin C may interfere with vitamin B12, so take doses at least 2 hours apart. Lower the dose if diarrhea develops.
  • Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Some clinicians are concerned about giving probiotics to severely immune-compromised patients. Speak with your physician.
  • Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support. People who are malnourished from alcoholism or other reasons, who have low levels of Thiamine (B1) should not take Alpha-lipoic acid without first increasing their levels of Thiamine due to potential for dangerous side effects.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

  • Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, immune, and anti-inflammatory effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
  • Rhodiola (Rhodiola rosea) standardized extract, 150 - 300 mg 1 - 3 times daily, for immune support. Rhodiola is an "adaptogen" and helps the body adapt to various stresses.
  • Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and immune stimulation. Cat's claw can potentially have negative effects in people who have leukemia and autoimmune disorders, and it can also interfere with many medications. Speak with your physician.
  • Turmeric (Curcuma longa) standardardized extract, 300 mg 3 times a day, for inflammation. Turmeric can have a blood-thinning effect and can interact with other blood-thinning medications, such as warfarin (Coumadin) and aspirin.
  • Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day. High doses of Reishi can have a blood-thinning effect and can interact with other blood-thinning medications, including warfarin (Coumadin) and aspirin. It can also have a blood  pressure lowering effect at high doses. Speak with your physician. 

Homeopathy

While few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths may recommend one or more of the following treatments for allergic reactions based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

  • Apis -- for hives with intense burning, as well as for swelling. People for whom this treatment is appropriate describe a stinging relieved by cool compresses.
  • Rhus toxicodendron -- for hives that are very itchy and relieved by warm compresses. A person for whom this is appropriate tends to be restless and must change positions frequently.
  • Urtica urens -- for hives and other red, raised rashes that are painful, burning, and stinging but relieved by rubbing.

Acupuncture

Traditional Chinese Medicine and acupuncture can help lessen the body's tendency toward allergic hypersensitivity reactions.

Massage

Do not use massage to treat serum sickness as it may promote inflammation and lower blood pressure.



Prognosis/Possible Complications:

Serum sickness usually improves in 7 - 10 days, with full recovery in 2 - 4 weeks. However, it may lead to nervous system disorders and a life-threatening allergic reaction called anaphylaxis, so it is important to get medical treatment.



Following Up:

Health care providers should monitor seriously ill people for rare instances of myocarditis (inflammation of the heart muscle) and peripheral neuritis (nerve inflammation).



Supporting Research:

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Bope and Kellerman: Conn's Current Therapy, 2012, 1st. ed. Philadelphia, PA: Saunders; 2011.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Maheshwari RK, Singh AK, Gaddipati J, Srimal RC. Multiple biological activities of curcumin: a short review. Life Sci. 2006;78(18):2081-7.

Marx: Rosen's Emergency Medicine, 7th ed. St. Louis, MO: Mosby; 2009.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47. Shi J, Yu J, Pohorly JE, Kakuda Y. Polyphenolics in grape seeds-biochemistry and functionality. J MedFood. 2003;6(4):291-9.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.

Wolverton. Comprehensive Dermatologic Drug Therapy, 2nd ed. Philadelphia, PA: Saunders; 2007.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.




Review Date: 12/28/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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