Immune Complex Disease (Serum Sickness)

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Introduction

Essentials of Diagnosis

• Fever, pruritus, and arthropathy.
• Reaction is delayed in onset, usually 7-10 days, when specific IgG antibodies are generated against the allergen.
• Immune complexes found circulating in serum or deposited in affected tissues.

General Considerations
Serum sickness reactions occur when immune complexes are formed by the binding of antigens (eg, drugs, heterologous serum) to antibodies. Deposition of these complexes in tissues or in vascular endothelium can produce immune complex-mediated tissue injury by activation of complement, generation of anaphylatoxins, chemoattraction of polymorphonuclear leukocytes, and tissue injury. The commonly affected organs include skin (urticaria, vasculitis), joints (arthritis), and kidney (nephritis).

Clinical Findings

A. Symptoms and Signs
Constitutional symptoms, such as drug fever, are common.

B. Laboratory Findings
The specific IgG antibody may be present in sufficient quantity in serum to be detected by the precipitin-in-gel method. Detection of these precipitating antibodies by gel diffusion can be useful in the diagnosis of allergic bronchopulmonary aspergillosis or hypersensitivity pneumonitis. ELISA will detect antibodies present in lesser amounts.

Circulating antigen-nonspecific immune complexes can be detected in a variety of malignancies and in autoimmune, hypersensitivity, and infectious diseases. Immunohistochemical techniques can identify immune complexes or complement fragments deposited in tissue biopsy specimens. Depressed serum levels of C3, C4, or CH50 may be sought as nonspecific evidence of immune complex disease with consumption of soluble factors.

The erythrocyte sedimentation rate is increased, and other nonspecific laboratory findings may include elevated hepatic aminotransferases or reduced complement levels. Circulating immune complexes may be found, but current assays are limited in sensitivity. Evidence of nephritis may be found by observing red cell casts at urinalysis.

Treatment
This disease is self-limited, so treatment is usually conservative. Aspirin will relieve the arthralgias. Antihistamines and topical steroids will control the dermatitis. Corticosteroid therapy may be necessary for serious reactions - especially glomerulonephritis, neuropathy, and other manifestations of vasculitis.

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My 19 month old daughter developed Serum Sickness after taking amoxicillin for a double ear infection. She is taking an oral steroid called Prednisolon to help with the hives, joint, face and limb swelling. She is usually a great sleeper and has no trouble going to bed on her own. For the past few nights, she has been up almost all night, refusing to sleep and needing to be active. My husband and I have tried taking her on a walk, giving her a bath, turning off all the lights in the house, giving her warm milk...nothing seems to help get her to sleep. She has been up until 11 PM, sleeps for a couple of hours and then is up until about 5 AM. The lack of sleep is taking a huge toll on my husband and me. I wanted to know if anyone has had a similar experience after giving your child an oral steroid. Any advice, suggestions, etc. would be helpful. Thank you!

posted by Franky on 11/07/2010 at 5:24 am -08:00