Serum sickness

Serum sickness - allergic reactions developing in response to parenteral introduction of alien protein (whey) and characterized by rash, arthralgia, edema, lymphadenitis, fever and other symptoms. For whey disease depends on the quality and quantity of entered serum. In the basis of the pathogenesis of the disease lies reaction antigen (protein) with the antibodies, resulting in the body in response to the introduction of alien protein (see Allergy). The severity of pathological changes may range from mild functional changes in the circulatory system to organic vascular and tissue lesions (hyperemia, stasis, bleeding, severe inflammation, swelling of collagen tissue, Mokoena and fibrinoidnogo rebirth).
The clinical picture. The incubation period of 2 to 12, usually 7-12 days. The disease starts acutely. Body temperature short-term drops to subnormal numbers on the injection of serum there is pain and swelling. Regional and other lymph nodes priuchayut. Soon develops fever, body temperature can reach 38-39 degrees. One of the leading symptoms of serum sickness is a rash: often it is polymorphic, maculopapular or erythematous, urticarnae, curly, sometimes the bark or skarlatinopodobnoy. The rash is always accompanied with painful itching. Face pale and puffy. Possible dangerous, but quickly passing laryngeal edema.
Pulse Ochsen, there is a decrease in blood pressure, shortness of breath. Possible neuritis, radiculitis, cerebral phenomenon, arthralgia, arthritis. Develop lakopenia with relative limfotsitoz, eosinophilia, thrombocytopenia; ROHE accelerated, the clotting of blood is slowed down. The process may be limited only to local manifestations (swelling, redness, itching, skin necrosis at the injection site). The duration of illness varies from several hours to 7-15 days. Serum sickness when re intramuscular serum may proceed with the development anaphylacticski shock (see Anaphylaxis). Immediately or shortly after injection stunning of the patient, collapse, reduced body temperature. Oglushennosti soon replaced by excitement, there convulsions, dyspnea, cyanosis, involuntary discharge of urine and feces, albuminuria, comes unconsciousness, possible death.
Forecast when serum sickness in most cases favourable. To differentiate serum sickness with a scarlet fever, measles, rubella, sepsis and other
Treatment: in shock urgently introduce a solution of epinephrine 1 : 1000 and 1 ml intramuscularly, 5% solution of ephedrine and 1 ml under the skin, 10% solution of calcium chloride 10 ml intravenously, heart funds. The patient needs to warm (hot-water bottles to the feet, hot tub). Effective steroids, antihistamines (diphenhydramine 0.03 g, pipolfen, suprastin 0,025 g 3 times daily for 5 to 7 days). In severe cases shown insulin 5-10 UNITS under the skin, followed by a drink 100-200 ml of 20% glucose solution. By reducing blood pressure appoint ephedrine, epinephrine, caffeine. From itching help warm baths, wiping menthol and salicylic alcohol, drugs bromine.
Prevention is to identify the patient's sensitivity to the serum. With this purpose the internal surface of the forearm intradermally injected 0.1 ml in 100-fold diluted therapeutic serum. The sample is considered positive if for 20 minutes and will appear swelling and redness at the injection site with a diameter 1-3 cm and more. In these cases, if there is no vital indications, serum better not to enter.
The introduction of serum carried out by the method of Besedki, which is in fractional introduction of serum: first injected subcutaneously 0.1 ml of serum within 30 minutes even 0.2 ml, and after 1 hour - intramuscularly rest of the prescribed dose.