Pediatric serum sickness

Introduction to pediatric serum disease Serum disease is a characteristic autoimmune disease caused by foreign antigenic substances (serum and other drugs such as penicillin, sulfonamide, etc.) entering the body. Clinically, there are many acute or subacute processes, such as elevated body temperature, urticaria, and joint symptoms during serum disease. basic knowledge The proportion of the disease: the incidence rate is about 0.001% -0.003% Susceptible people: children Mode of infection: non-infectious Complications: Guillain-Barré syndrome, peripheral neuritis, asthma

Pediatric serum disease etiology

Causes:

After receiving the heterogeneous serum, the human body begins to develop after a latency of 7 to 14 hours. If the same serum is injected again by the person who has injected the animal serum, the serum reaction can be accelerated. In the pediatric department, the disease currently requiring anti-toxic serum is almost only diphtheria and tetanus. . Certain drugs such as penicillin, sulfonamides, etc. can also cause serum diseases.

Pathogenesis:

Serum disease is a typical example of type III allergic disease. In the case of excess antigen, an antigen-antibody complex is formed and deposited on the basement membrane of the whole body capillaries to activate complement and cause tissue damage.

The immune complex activates complement, frees anaphylatoxin, further releases histamine, enhances vascular permeability; and produces chemokines that cause neutrophils to aggregate, and aggregated neutrophils phagocytose antigen-antibody complexes, releasing lysozyme The body causes local tissue damage. In addition, the antigen-antibody complex can activate the kinin system to produce an acute inflammatory effect. In a few serious cases, glomerulonephritis and serum complement components may be decreased. The urticaria that occurs during serum disease is IgE-like antibodies are caused, and the symptoms of joints are the result of joint deposition of immune complexes composed of IgG and IgM antibodies and antigens.

Pediatric serum disease prevention

1. Try to avoid using horse serum or other animal serum.

2. Skin test: If you must use horse antiserum, you should do a skin test, use a 1:10 dilution, if the skin test is negative, you can intradermally inject 0.02ml 1:1 million dilution, if still no reaction, Later skin tests can be used at 1:1000. If still negative, the final concentration is 1:100. Negative skin reaction to concentrated solution indicates that no allergic reaction to horse serum is possible, such as anaphylactic shock, but skin test cannot Predict whether serum disease can occur.

3. Rapid desensitization therapy: those who have previous history of serum allergies or positive skin tests, but must use horse serum. At this time, anti-toxin can be successfully used in rapid desensitization therapy, and adrenaline and anti-drug can be used at the beginning of desensitization. Histamine drug, desensitization process: 0.1ml antiserum, diluted to 1:100,000 ~ 1:1, intravenous injection interval of 20min, if the patient can tolerate the previous injection, no side effects, the injection dose can be every 20min Double, in general, the total amount of antiserum can be given within 4 to 6 hours, but desensitization is only temporary, patients often get the same allergic reaction in a few months, the use of methylprednisolone can not prevent the occurrence of serum disease .

Pediatric serum complications Complications Guillain-Barré syndrome peripheral neuritis asthma

Combined with carditis, glomerulonephritis is rare, the most serious comorbidity of serum disease is Guillain-Barre syndrome, peripheral neuritis is caused by edema or polyarteritis involving nerve tissue, occasionally complicated by asthma, serum Children with earlier symptoms appear more likely to have asthma.

Symptoms of serum sickness in children Common symptoms Lymph node enlargement Joint pain, fever, edema, vascular neuropathic edema, scarlet fever-like rash

Typical serum disease occurs 7 to 12 days after the injection of allogeneic antigen, and also as late as 3 weeks. If there is contact with the same allogeneic antigen in the past, the symptoms appear in a rapid manner, and symptoms may appear 1 to 3 days after the injection. The main symptoms are fever, rash, angioedema, lymphadenopathy and joint pain. The rise in body temperature (38-40 °C) is often the first symptom, but sometimes it can be seen before the rash or both, the rash is mostly For urticaria, occasionally measles or scarlet fever-like rash, ring rash, purpura, or several types of rashes are mixed together. The rash often appears in the serum part of the injection, spreading the whole body in a short time, and the rash on the compression site is often dense. Deeper, such as the belt, the serious condition, eyelids, cheeks, and even hands and feet are edema, systemic lymphadenopathy is a common symptom, joint pain is rare, local redness is rare, but the size of joints can be affected, Such as sputum, knee, waist, wrist, finger toe, the disease is generally a self-limiting process, patients recover more than 7 to 10 days, most children are generally in good condition, all symptoms and signs can gradually Sex subsided.

Pediatric serum disease examination

Increased total number of white blood cells, often accompanied by increased eosinophils, increased erythrocyte sedimentation rate, often seen significant thrombocytopenia, mild proteinuria, hemoglobinuria and microscopic hematuria, serum complement decreased, serum disease caused by horse serum albumin, can be Specific antibodies against horse serum albumin found in serum, such as IgG, M, E, A, direct immunofluorescence of diseased skin can be found in the deposition of IgM, IgA, IgE or C3.

According to the clinical clinical selection X-ray chest X-ray, ECG and other examinations.

Diagnostic identification of pediatric serum disease

Combined with the injection of serum or the use of penicillin, the history of sulfonamides and other typical clinical manifestations, the diagnosis is not difficult.

Cases with more prominent fever and joint pain prior to the history of medications listed above are easily confused with rheumatoid or rheumatoid arthritis. When fever and lymphadenopathy are the main symptoms, it can be similar to infectious mononucleosis. When there is a measles-like or scarlet-like fever-like rash, it can also cause suspicion of diagnosis. However, based on the characteristics of the above diseases and the typical pathogenesis of serum diseases, the differential diagnosis is relatively simple.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.