Serum sickness and serum sickness-like reactions
Introduction
Introduction to serum disease and serum disease-like reactions Serum disease is an immune complex reactive disease caused by receiving non-protein substances such as allogeneic serum proteins and their products or drugs in the body, and the degree of the disease is directly related to the received pathogenic substances. The disease occurs within 1 to 3 weeks after the application of a large amount of antigenic substances such as serum or globulin. A small number of people who have had a history of the same serum vaccination can occur within 1 to 3 days after vaccination. The extent and timing of the onset is related to the route of vaccination and the dose of the antigen, that is, it is easy to be ill and is heavier when administered intravenously and in large doses. basic knowledge The proportion of illness: 0.001% Susceptible people: more than children Mode of infection: non-infectious Complications: polyneuritis nephritis myocarditis
Cause
Serum and serum sickness-like causes
Pathogens (25%):
Common pathogens are serum proteins, non-protein drugs are penicillins, sulfonamides, streptomycin, phenytoin, thiouracils. Currently, there are few diseases treated with anti-venom, only diphtheria, tetanus and 12 diseases such as botulism, and the incidence of such diseases has been significantly reduced in recent years due to the widespread use of preventive vaccines. However, in recent years, due to the continuous development of clinical immunology, more and more biological products, various There are more and more non-protein drugs with chemical structures, and the incidence of serum-like reactions is increasing in clinical practice. This is a new problem for clinicians, and the rational application of biological products and hapten drugs. is crucial.
Immune complex (20%):
When the pathogenic substance containing serum protein enters the body, after 2 to 3 weeks, the specific antibody can be produced in the body. If the pathogen is still present in the human body, it can be used as an antigen or a hapten. These antibodies form immune complexes and deposit on the vascular bed, and activate the classical pathway of complement, a series of inflammatory reactions, clinically appearing serum and serum-like reactions, the inflammatory process is mainly caused by immune complex activation and phagocytosis Cells and immunocompetent cells secrete a large number of cytokines and inflammatory mediators. After the first dose of heterologous serum or non-protein drugs, symptoms do not appear. This is because the body still has enough antibodies to form immune complexes with foreign antigens. The substance is removed from the body, but when the same antigen is received again, some of the sensitized B lymphocytes are rapidly converted into plasma cells, secreting a large amount of antibodies and binding to the antigenic substance to form an immune complex, causing a rapid serum reaction.
Pathological changes (10%):
The histopathological changes of this disease are similar to those of type III allergic diseases such as rheumatic fever and nodular polyarteritis, but to a lesser extent. The pathological changes include small vessel dilatation, granulocyte infiltration and edema. The cell infiltration is mainly lymphocytes, neutrophils and eosinophil infiltration; the pathological changes in the kidney are heavier, with focal ischemia and cellulose deposition.
Prevention
Serum disease and serum disease-like reaction prevention
Strictly grasp the application indications of drugs and serum products, and use the route of intravenous administration as little as possible. The biological and chemical synthetic preparations that need to be skin test before administration should be strictly used after skin test, or used after desensitization.
Complication
Serum and serum-like reaction complications Complications, polyneuritis, nephritis, myocarditis
Individual patients with serum or globulin macromolecules cause severe disease and more organ damage, and it is prone to serious damage such as polyneuritis, nephritis and myocarditis.
Symptom
Symptoms of serum disease and serum-like reaction symptoms Common symptoms Windy lymph nodes swollen throat edema nausea and vomiting abdominal pain nausea
The disease occurs within 1 to 3 weeks after the application of a large number of antigens such as heterologous serum or globulin. A few patients who have had the same history of serum vaccination can occur within 1 to 3 days after vaccination. The extent and timing of morbidity and vaccination The route is related to the dose of the antigen, that is, it is easy to be ill and is heavier when administered intravenously and in large doses.
The early clinical symptoms of the disease usually start from the local injection, gradually to the other parts of the body urticaria-like wheal, purpura-like rash or measles-like rash, body temperature gradually increased to 38 ~ 39 ° C, followed by systemic lymph nodes Swelling, swollen lymph nodes are soft and tender, most patients have joint pain, but there is very little chance of developing arthritis. Some patients can also have facial, eyelid and edema at the end of the hands and feet, especially in children, but very There is little laryngeal edema, and some patients have abdominal pain, nausea, vomiting and other manifestations while having fever.
Examine
Examination of serum and serum-like reactions
Blood routine red blood cells rise, but eosinophils are generally not high, serum total complement and IgG decrease. Tissue biopsy is based on small vessel dilatation, granulocyte infiltration and edema.
Diagnosis
Diagnosis and identification of serum and serum-like reactions
The main basis for the diagnosis of this disease is the history of injection of large molecules or macromolecular substances such as serum or globulin, combined with the above clinical manifestations, laboratory tests, if the above conditions are met, it is not difficult to diagnose the disease, but the laboratory tests the disease. Diagnosis is neither specific nor of great value, so it should not be relied too much.
