SURVIVAL DISEASE

SURVIVAL DISEASE - an allergic disease that occurs when parenterally administered with the therapeutic or prophylactic purpose of serums or their preparations containing large amounts of protein. It is manifested by fever, joint pain, erythema and enlarged lymph nodes. The cause of the development of the disease is the introduction of an alien protein into the body with sera. The development of the syndrome of serum sickness is also possible with the use of certain medications (for example, insulin) containing protein of animal origin. Antitoxic serums against diphtheria, tetanus, botulism, gas gangrene, venom snakes are derived mainly from the blood of horses. The development of serum sickness is facilitated by the presence of preliminary sensitization as a result of inhalation of horse dandruff, eating horse meat that has an antigenic relationship to horse serum proteins.

The main mechanism of the development of the disease is the immunological one. It includes the damaging effect of circulating immune complexes, which, with sufficient magnitude and some excess antigen, are deposited in the vascular wall, increasing its permeability. Vascular and tissue damage occurs with the active participation of class G immunoglobulins. In addition, with serum sickness IgE antibodies are formed, whose participation in the pathological process leads to the release of histamine, serotonin and platelet-activating factor. All this causes further damage to the vessels and connective tissues of the organs.

Clinical picture . Depending on the severity of light, medium and heavy forms; In duration - acute, subacute and protracted; By nature - a typical and atypical serum sickness. With the first introduction of serum, the disease develops, as a rule, on the 7th-12th day, less often this process is delayed until the 20th day. With the repeated administration of serum, the latent period of the disease is reduced to 1-6 days. The incidence and severity of the disease increase with age. There is a connection between the amount of serum administered, the frequency of the disease and its severity.

Characteristic symptoms: increased body temperature, increased lymph nodes, rashes on the skin, swelling, pain in the joints. Often develop acute emphysema of the lungs, myocarditis , glomerulonephritis , polyneuritis , synovitis , hepatitis, necrosis of subcutaneous tissue are possible. Skin rashes are polymorphic: there may be urticaria, erythematous scarlet fever or korepodobnye rashes with severe itching. With the repeated administration of serum, there is an increase in the severity of the symptoms, the disease can proceed according to the type of anaphylactic shock. Changes in blood at the height of the disease are characterized by leukopenia with relative lymphocytosis. ESR is low at the onset of the disease, and may subsequently increase.

The diagnosis is made on the basis of information on the introduction of serum or other protein preparations and a characteristic clinical picture. Differential diagnosis is carried out with measles, scarlet fever, medicinal exanthems, rheumatism.

Treatment . In those cases when serum sickness develops as anaphylactic shock, treatment measures - see Anaphylaxis . In severe cases of the disease, especially with lesions of the heart, joints, nervous system, corticosteroids are used, usually a short course. With pronounced joint manifestations, non-steroidal anti-inflammatory drugs (brufen, voltaren, analgin, sometimes delagil) are prescribed, with edema - diuretics. Antihistamines (suprastin, pifolen, tavegil, etc.), adrenaline, calcium preparations are widely used, they are effective enough for lighter forms of the disease. To reduce itching, warm baths are recommended, wiping 1-5% with menthol alcohol solution. According to the indications, other symptomatic agents are prescribed. Hospitalization is subject to patients with anaphylactic shock, as well as with severe and moderate forms of serum sickness.

The prognosis is usually favorable, except for cases of anaphylactic shock.

Prevention consists in the further improvement of purified and concentrated serums and gamma globulins, in limiting the use of sera according to strict indications. With the available sensitization to horse dander, horse serum uses human gamma globulin. Persons suffering from serum sickness are not allowed to eat horse meat, contact with horses.

To detect increased sensitivity to serum, preliminary testing is performed in the form of a skin scarification test: a drop of aqueous serum solution is applied to the skin, first in a dilution of 1: 100, and then (in the absence of a reaction) in a dilution of 1:10. If the result is negative, an intradermal test is performed with 0.02 ml of serum in a 1: 1000 dilution (in individuals predisposed to allergic reactions) and 1: 100. With positive samples, human gamma globulin is used. Therapeutic administration of sera is performed according to the method of Beside with the simultaneous administration of antihistamines and epinephrine.