Serum sickness results from a reaction to an antigen, a protein that the body
recognizes as foreign. The classic example of a cause of serum sickness is an
antiserum administered following a snakebite to counter the poisonous venom.
Today, the most common cause of serum sickness is the antibiotic penicillin.
Serum sickness will usually develop within 7 to 10 days after initial exposure
to the antigen; at times, however, the reaction does not develop until as long
as three weeks later. With subsequent exposures, serum sickness tends to develop
more rapidly (within one to four 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 lesions, possibly including bruise-like patches from bleeding
into the skin; a faint red discoloration over the hands, fingers, feet, and toes
before other lesions or a brighter rash erupt; hives
- Joint pain
- Malaise (feeling unwell)
- Swollen lymph nodes
- Swelling, especially around the face and neck
- Runny nose
- Rarely, low blood pressure, as with anaphylaxis (a severe, total body
- Muscle pain
- Diarrhea, nausea, abdominal cramping
|What Causes It?|
Antigens, the proteins described earlier, stimulate the body to produce
antibodies. These antibodies form complexes with the antigens and, in the case
of serum sickness, become trapped on endothelial
surfaces—layers of cells that line the heart, blood
vessels, lymph vessels, and other body cavities. This leads to a series of
immune-system reactions that cause the symptoms of serum sickness.
Penicillins are the most common cause of serum sickness. Other causes
- Other antibiotics; fluoxetine used for depression; barbiturates; a
class of diuretics called thiazides; aspirin-containing products;
propylthiouracil used for overactive thyroid; and hydantoins used for
- Influenza vaccine
- Snake venom antiserum
- Diphtheria and tetanus antisera; no longer happens generally because
these are now prepared from human origin as opposed to foreign species as was
done years ago
- Bee or wasp sting - not
|Who's Most At Risk?|
You are more likely to suffer from serum sickness if
- A drug or antitoxin known to cause serum sickness is delivered by
- High quantities of snake venom antiserum are required
- If there has been past exposure to a drug or antitoxin known to cause
|What to Expect at Your Provider's Office|
A healthcare provider will look for typical signs and symptoms and ask about
recent exposure to any antiserum. Blood and urine tests and tests of skin with
lesions may aid the diagnosis.
- If you are aware of a hypersensitivity to a particular drug or other
agent, you should tell your healthcare provider before you get any kind of
- A healthcare provider can perform skin tests to check for serum
sensitivity before giving antiserum.
- Once a hypersensitivity is identified, your healthcare provider may
use a method that desensitizes you to the antiserum, at least temporarily.
- Because of their potential to cause serum sickness, serum from animals
should be avoided unless there is no other treatment option.
Doctors will typically prescribe antihistamines or analgesics for serum
sickness. If symptoms don't respond to this treatment, they may prescribe
corticosteroids, such as prednisone. Normally, there is no need for
hospitalization. In severe cases providers may resort to
plasmapheresis—a procedure for removing blood,
separating plasma from the blood, then replacing the blood along with plasma
|Complementary and Alternative Therapies|
Serum sickness requires immediate conventional medical attention. Scientific
studies have not yet evaluated the effectiveness of CAM therapies in treating
serum sickness. However, nutritional and herbal treatments may support
conventional treatment by helping to reduce inflammation and stabilize the
immune system. Although certain CAM measures may help relieve symptoms of serum
sickness, others may worsen serum sickness by increasing the number of
circulating immune complexes (see section entitled What Causes It? for
description of immune complexes).
Certain nutrients used in clinical practice can stabilize immune function and
may lessen reactions such as serum sickness. These include:
- Vitamin C
- L-methionine (an amino acid or protein building block obtained from
- Choline (considered part of the vitamin B complex; found in meat and
- Inositol (considered part of the vitamin B complex; found in fruits,
vegetables, whole grains, and organ meats)
The use of these substances for serum sickness is theoretical and has not
been tested scientifically.
Omega-3 fatty acids, found in fish oil, are generally used to reduce
inflammation; however, these substances along with eicosapentanoic acid (EPA),
should be avoided in the case of serum sickness because of a recent animal study
showing increased levels of antigen-antibody immune complexes following
ingestion of fish oil. Increased circulation of immune complexes may worsen
Anti-inflammatory herbs may, theoretically, lessen some of the symptoms of
- Eleuthro root (Eleutherococcus senticosis), frequently marketed
as Siberian ginseng—used for inflammatory
- Ginkgo (Ginkgo biloba)—may decrease
- Licorice root (Glycyrrhiza glabra)—may
- Milk thistle (Silybum marianum)—may
- Peppermint oil (Menthae piperitae
aetheroleum)—approved in Germany to treat
- Turmeric (Curcuma longa)—may decrease
inflammation and swelling, particularly when used in conjunction with a
supplement called bromelain; rarely, though, bromelain may cause an allergic
Toki-shakuyaku-san (TSS), a Japanese (Kampo) formula that contains six herbs,
was found to decrease circulating immune complexes in animals. The main active
ingredient to help clear the complexes was thought to be:
- Angelica root (Angelica
Herbs that may cause allergic hypersensitivity reactions, such as cayenne
pepper (Capsicum spp., used to treat forms of arthritis), should
be avoided in the case of serum sickness.
To date, no scientific studies have investigated the value of homeopathic
remedies in treating serum sickness. However, homeopaths commonly use the
following for hives and other symptoms related to serum
- Apis for hives with intense burning as well as for swelling;
people for whom this treatment is appropriate describe a stinging relieved by
- 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
An experienced homeopath considers each individual case and may recommend
treatments to address both the underlying condition and any current
Massage should not be used in cases of serum sickness as it may promote
inflammation as well as lower blood
Serum sickness usually resolves in 7 to 10 days, with full recovery in 2 to 3
weeks. However, it may lead to nervous system disorders as well as a
life-threatening allergic reaction called anaphylaxis.
Healthcare providers should monitor acutely ill persons for rare instances of
myocarditis (inflammation of the heart muscle) and peripheral neuritis (nerve
Behrman RE, ed. Nelson Textbook of Pediatrics. 15th ed. Philadelphia,
Pa: W.B. Saunders Co; 1996.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded
Commission E Monographs. Newton, Mass: Integrative Medicine Communications;
2000:3-6, 33-35, 52-54, 106-109, 160-169, 233-239, 257-263, 300-303,
Boyer LV, Seifert SA, Clark RF, et al. Recurrent and persistent coagulopathy
following pit viper envenomation. Arch Intern Med.
Brenner BM, Rector FC. The Kidney. Philadelphia, Pa: W.B. Saunders Co;
Canale ST. Campbell's Operative Orthopaedics. 9th ed. St. Louis, Mo:
Mosby Inc; 1998.
Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th
ed. Philadelphia, Pa: W.B. Saunders Co; 1996.
Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md:
Lippincott Williams & Wilkins; 1999.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill Book Co; 1998.
Feigen GA, Smith BH, Dix CE, et al. Enhancement of antibody production and
protection against systemic anaphylaxis by large doses of vitamin C. Res
Commun Chem Pathol Pharmacol. 1982;38(2):313-333.
Iijima K, Tanaka M, Toriizuka K, Cyong JC. Effects of Kampo medicines on the
clearance of circulating immune complexes in mice. J Ethnopharmacol.
Middleton E, ed. Allergy: Principles and Practice. 5th ed. St. Louis,
Mo: Mosby-Year Book; 1998.
Proctor BD, Murray PG, Joondeph BC. Bilateral anterior uveitis: a
feature of streptokinase-induced serum sickness. N Engl J Med.
Rakel RE, ed. Conn's Current Therapy. 51st ed. Philadelphia, Pa: W.B.
Saunders Co; 1999.
Tateno S, Kobayashi Y, Robinson DR. Dietary fish oil supplementation
exacerbates serum sickness nephritis in mice. Nephron.
Wilde JA, McMillan JA, Serwint J, Butta J, O'Riordan MA, Steinhoff MC.
Effectiveness of influenza vaccine in health care professionals: a randomized
trial. JAMA. 1999;281(10):908-913.
|Review Date: December 2000|
|Reviewed By: Participants in the review process include: Amy Atar, MD, Infectious Disease
Specialist and HIV Consultant, Cambridge City Hospital, Cambridge, MA;
Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor Integrative Medicine,
Boston, MA; David Winston, Herbalist, Herbalist and Alchemist, Inc., Washington,
NJ; Leonard Wisneski, MD, FACP, George Washington University, Rockville,
Copyright © 2004 A.D.A.M., Inc
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed