serum sickness
Introduction
Introduction to serum disease Serum disease (emrussickness) refers to an immune complex disease caused by the injection of exercise immune serum, which mainly manifests as rash, fever, joint pain, and swollen lymph nodes. At present, the clinical application of immune serum has been reduced, and it is limited to the prevention and treatment of diphtheria, tetanus, certain snake bites, and immunosuppressive therapy to prevent graft rejection. On the contrary, drug sensitization has become the most common serum disease today. Cause. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: Myocarditis, polyneuritis
Cause
Cause of serum disease
Allergic reaction (20%):
Serum disease is a typical type III allergic reaction. The body can produce antibodies by forming antigenic complex proteins formed by the combination of various antigen components of heterologous serum or certain drugs as haptens and in vivo proteins. When the amount is slightly less than the antigen that disappears in the body, it can form an immune complex deposited on the blood vessel wall, which in turn activates the complement system, generates vascular substances, neutrophil chemotactic factors, etc., causing local congestion and edema, neutral The infiltration of granulocytes and the release of proteolytic enzymes in lysosomes lead to inflammation and damage of tissues. The antibody globulins that constitute the immune complex of serum diseases are mainly IgG, but if there is more IgE, the increase of serum permeability at the time of onset. More obvious, and may have laryngeal edema, hypotension and even anaphylactic shock, where antigen-stimulated IgG and IgE are more likely to produce serum disease.
At present, the serum preparations causing serum diseases mainly include tetanus antitoxin, diphtheria antitoxin, various snake venom antitoxins and anti-lymphocyte globulin (ATG); the drugs causing serum diseases are mainly penicillin, streptomycin, sulfonamides, water. Macromolecular drugs such as salicylate, phenylprednisolone, phenytoin, and dextran.
Prevention
Serum disease prevention
Grasp the indications for the use of drugs and serum immunological products, and minimize the route of intravenous administration. If you must apply heterologous serum products, you should first carefully ask if there is a history of allergies and previous history of serum application, and then you must do a skin sensitivity test. Methods as below:
1 First, take a drop of undiluted serum, place it on the flexor side of the forearm, and then use the sterile needle tip to make a number of strokes in the serum drop (without bleeding).
2 If there was no reaction for half an hour, 0.1 ml of serum diluted 1:10 was used for intradermal test.
3 After another 20 minutes of observation, there is no erythema or induration with a diameter of more than 1 cm at the injection site, or there is no pseudo-foot-like papule around it, so that the serum can be injected into the muscle.
If the skin test is positive, it should be used as much as possible. If serum is necessary, it can be desensitized according to the following method:
1 oral antihistamine 25 ~ 50mg.
After 2 and a half hours, 0.1 ml of serum diluted 20 times was injected subcutaneously.
3 After 20 minutes, subcutaneously inject 0.1 ml of serum diluted 10 times.
After 420 minutes, if there is still no ruminant, it is difficult to steal. 1ml subcutaneous injection.
5 After another 15 minutes of observation, it was confirmed that no reaction, that is, subcutaneous injection of 0.2 ml, 0.5 ml of 0, 1.0 ml and 2.0 ml every 15 minutes, and finally subcutaneous or intramuscular injection with the remaining amount.
In desensitization and injection of serum, adrenaline and adrenocortical hormone must be prepared to prevent allergic sensitization shock. In the desensitization process, 0.1% adrenaline 0.1 to 0.3 ml subcutaneous injection can be applied at any time, as appropriate. To counteract the possible reaction, after desensitization to complete the injection allowance, it should still be observed for 1-3 hours to prevent the occurrence of delayed reaction.
Complication
Serological complications Complications Myocarditis Polyneuritis
Common complications of this disease:
1. Facial, eyelids and edema at the end of the hands and feet (more common in children), very few patients may have laryngeal edema.
2. Abdominal pain, nausea, vomiting.
3. Joint pain, swelling and other arthritis symptoms, often involving multiple joints, showing symmetry.
4. There are few serious complications such as polyneuritis, glomerulitis or / and myocarditis.
Symptom
Symptoms of serum disease Common symptoms Skin itching whipping fever Nausea lymphadenopathy Abdominal pain Joint pain Throat edema
The disease occurs more than 1 to 3 weeks after a large dose of heterologous serum or globulin. A small number of patients, especially those who have had a weekly serum vaccination, can occur within 1 to 3 days after vaccination. The degree and extent are related to factors such as the route of vaccination (increased chance of intravenous injection) and the dose of serum injected.
The rash is the most obvious and common symptom of this disease, mainly urticaria-like wheal, purpura-like rash or measles-like rash; often occurs at the injection site, fever often rises, up to 38 ~ 39 ° C, with the whole body The degree of lymph node is swollen, soft and slightly tender. Some patients may have facial, eyelid and edema at the end of the hand and foot (more common in children). Very few patients may have laryngeal edema, and some patients are in the same fashion of fever. Abdominal pain, nausea, vomiting, etc., caused by serum or globulin (such as atg) or other macromolecular drugs, 2 days after the appearance of rash, there may be joint pain, swelling and other arthritis symptoms, often involving multiple joints, Symmetry, few major complications such as polyneuritis, glomerulitis or / and myocarditis.
Examine
Serum disease check
1. The total number of white blood cells is moderately elevated, but the increase in eosinophils is seen; the reason for the low white blood cells is that white blood cells are a kind of nucleated blood cells. The number of blood cells in a normal person is 4000-10000/L (microliter). Under different functional times and different functional states of the body, the number of white blood cells in the blood has a wide range of changes. When there are more than 10,000 per microliter, it is called leukocytosis; when it is less than 4000 per microliter, it is called leukopenia. When the body has inflammation (ie inflammation), leukocytosis occurs; leukopenia may be hereditary, Familial, acquired, etc. Among them, gain is the majority. Drugs, radiation, infections, toxins, etc. can all reduce granulocytes, and drugs are most common. Avoid medication to avoid leukopenia caused by the drug.
2. Serum total complement and c3 can be reduced, and sometimes immune complexes can be found in the blood.
Diagnosis
Diagnosis and identification of serum diseases
The diagnosis of this disease, the most important is the injection of serum or atg history and the above-mentioned characteristic clinical manifestations, small molecule drugs rarely cause neuritis, glomerulonephritis or systemic lymphadenopathy.
Laboratory tests have little help for this disease. Usually, the total number of white blood cells is moderately elevated, but the increase in eosinophils is seen. The total serum complement and c3 can be decreased. Sometimes, immune complexes can be found in the blood. Can help the diagnosis of this disease, but the specificity is not strong.
The disease can be judged based on medical history and clinical data, and does not need to be differentiated from other diseases.
