SERUM DISEASE - an allergic disease that occurs with parenteral administration for therapeutic or prophylactic purposes of sera or their preparations containing a large amount of protein. Manifested by fever, joint pain, erythema and swollen lymph nodes. The cause of the development of the disease is the introduction of a foreign protein into the body with sera. The development of serum sickness syndrome is also possible with the use of certain medications (for example, insulin) containing animal protein. Antitoxic serums against diphtheria, tetanus, botulism, gas gangrene, snake venom are obtained mainly from the blood of horses. The development of serum sickness is facilitated by the existing preliminary sensitization as a result of inhalation of horse dandruff, eating horse meat that have antigenic affinity for horse serum proteins.
The main mechanism for the development of the disease is immunological. It includes the damaging effect of circulating immune complexes, which, with their sufficient size and a certain excess of antigen, are deposited in the vascular wall, increasing its permeability. Damage to blood vessels and tissues occurs with the active participation of class G immunoglobulins. In addition, antibodies of the IgE class are formed in serum sickness, the participation of which in the pathological process leads to the release of histamine, serotonin and a platelet-activating factor. All this causes further damage to the vessels and connective tissue of the organs.
The clinical picture . Depending on the severity, there are mild, moderate and severe forms; by duration - acute, subacute and lingering; by nature - typical and atypical serum sickness. At the first administration of serum, the disease develops, as a rule, on the 7-12th day, less often this process is delayed until the 20th day. With repeated administration of serum, the latent period of the disease is reduced to 1-6 days. The incidence and severity of the disease increases with age. There is a relationship between the amount of serum administered, the incidence of the disease, and its severity.
Typical symptoms: fever, swollen lymph nodes, skin rashes, swelling, joint pain. Often acute pulmonary emphysema, myocarditis , glomerulonephritis develop, polyneuritis, synovitis, hepatitis, subcutaneous tissue necrosis are possible. Skin rashes are polymorphic: urticaria , erythematous scarlet-like or measles-like rashes with severe itching can be observed. With repeated administration of serum, an increase in the severity of symptoms is noted, the disease can proceed as anaphylactic shock. Blood changes at the height of the disease are characterized by leukopenia with relative lymphocytosis. ESR is low at the onset of the disease, in the future may increase.
The diagnosis is established on the basis of information about the introduction of serum or other protein preparations and the characteristic clinical picture. The differential diagnosis is carried out with measles, scarlet fever, medicinal exanthema, rheumatism.
Treatment . In cases where serum sickness develops as anaphylactic shock, therapeutic measures - see Anaphylaxis . In severe cases of the disease, especially with damage to the heart, joints, nervous system, corticosteroids are used, as a rule, in a short course. With pronounced articular manifestations, non-steroidal anti-inflammatory drugs (brufen, voltaren, analgin, sometimes delagil) are prescribed, with edema - diuretics. Antihistamines (suprastin, pipolfen, tavegil, etc.), adrenaline, calcium preparations are widely used, they are quite effective in milder forms of the disease. To reduce itching, warm baths are recommended, wiping with a 1-5% alcohol solution of menthol. According to the indications, other symptomatic agents are prescribed. Hospitalization is required for patients with anaphylactic shock, as well as with severe and moderate forms of serum sickness.
The prognosis is usually favorable, except in cases of anaphylactic shock.
Prevention consists in the further improvement of purified and concentrated serums and gamma globulins, in limiting the use of serums according to strict indications. With the existing sensitization to horse dandruff, horse serum, human gamma globulin is used. Persons who have had serum sickness are not allowed to eat horse meat or come into contact with horses.
To identify increased sensitivity to serum, preliminary testing is carried out in the form of a skin scarification test: a drop of an aqueous solution of serum is applied to the skin, first at a dilution of 1: 100, and then (in the absence of reaction) at a dilution of 1:10. If the result is negative, an intracutaneous test is performed with 0.02 ml of serum at a dilution of 1: 1000 (in individuals predisposed to allergic reactions) and 1: 100. For positive samples, human gamma globulin is used. Therapeutic administration of sera is carried out according to the method of Unlimited with the simultaneous administration of antihistamines and adrenaline.