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Serum Sickness

Serum Sickness is a topic covered in the 5-Minute Emergency Consult.

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  • Type III hypersensitivity reaction
  • When a foreign protein or drug (the antigen) is injected, the body's immune system responds by forming antibodies to the foreign material and subsequently forms complexes composed of the antigen, antibody, and complement.
  • These complexes then deposit in tissue, inciting an inflammatory response:
    • C3a and C5a act as anaphylatoxins.
    • C5a is strongly chemotactic for neutrophils.
    • The neutrophils then infiltrate the vessel wall at the site of the immune complex deposition and release enzymes, such as collagenase and elastase, which damage vessel walls.
  • Typically, symptoms arise 6–21 days after the primary exposure to the antigen.
  • Symptoms can start 1–4 days after exposure if there has been an initial immunizing exposure.
  • Symptoms typically last 1–2 wk before spontaneously resolving.


  • Serum sickness:
    • Vaccines containing foreign protein or serum such as pneumococcal vaccine or rabies.
    • Antivenom and tetanus inoculations made with horse or sheep protein
    • Monoclonal antibodies
  • Serum sickness–like reaction:
    • Caused by nonprotein drugs, mostly antibiotics:
      • Penicillins, amoxicillin
      • Cephalosporins (i.e., Cefaclor)
      • Sulfonamides (i.e., Bactrim)
      • Thiazides
      • Gold
      • Thiouracils
      • Hydantoins
      • Phenylbutazone
      • Aspirin
      • Streptomycin

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Rosen, Peter, et al., editors. "Serum Sickness." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307429/all/Serum_Sickness.
Serum Sickness. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307429/all/Serum_Sickness. Accessed April 23, 2019.
Serum Sickness. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307429/all/Serum_Sickness
Serum Sickness [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307429/all/Serum_Sickness.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Serum Sickness ID - 307429 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307429/all/Serum_Sickness PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -