Serum Sickness

Originally published at Pediatric EM Morsels on January 10, 2014. Reposted with permission.

Follow Dr. Sean M. Fox on twitter @PedEMMorsels


This little Morsel stems from a intellectually fun conversation with Dr. Modisett (for those of you overseas, Dr. Modisett is one of our brilliant and illustrious Chief Residents at Carolinas – yes, I am spoiled).  This is another great reason to discuss not throwing antibiotics at every kid with an ear.

Serum Sickness Basics

  • Serum Sickness is considered a Type III hypersensitivity reaction.
    • Follows the administration of Foreign Proteins or Chemicals.
    • Antigen-antibofy complexes get deposited along the basement membranes of small vessels.
  • An inflammatory response occurs that leads to joint, skin, and systemic manifestations.
  • The true pathophysiology is unclear.
  • It is a self-limited condition, but the presentation can be quite dramatic and concerning to families.
    • 50% of children, in one study, required hospitalization due to severe symptoms.

Serum Sickness Presentation

  • Serum Sickness and “Serum Sickness-Like Reactions” are similar in presentation.
  • Fever
  • Rash (most often uricaria)
  • Arthralgias/Arthritis
  • Malaise
  • Lymphadenopathy
  • Proteinuria
  • Serum Sickness – Like Reaction

    • Often used when referring to medication associated reactions.
    • Differs from Serum Sickness in that it infrequently has associated proteinuria and lymphadenopathy.
    • More often reported in children.
    • More likely to occur during or following a second course of antibiotics (particularly Cefaclor).
    • Often occurs within the first 1 to 3 weeks after initiation of the offending drug.

Serum Sickness Causes

  • Anti-venom created from Horse Serum.
    • Historically, the term was derived the administration of Horse Serum that had been given to treat Diptheria. Ah, yes… the good ol’days.
  • Antibiotics
    • Penicillins / Amoxicillin
    • Cefaclor
    • Cefprozil
    • Cefazolin
    • Ciprofloxacin
    • Minocycline
  • Thiazide Diuretics
  • Many other medications.

Serum Sickness Treatment

  • Steroids and antihistamines have been used — no real data to show utility.
  • Stop offending agent!
  • Give analgesics!
  • Supportive care.


Brucculeri M, Charlton M, Serur D. Serum sickness-like reaction associated with cefazolin. BMC Clin Pharmacol. 2006 Feb 23;6:3. PMID: 16504095. [PubMed] [Read by QxMD]

Chao YK, Shyur SD, Wu CY, Wang CY. Childhood serum sickness: a case report. J Microbiol Immunol Infect. 2001 Sep;34(3):220-3. PMID: 11605816. [PubMed] [Read by QxMD]

Vial T, Pont J, Pham E, Rabilloud M, Descotes J. Cefaclor-associated serum sickness-like disease: eight cases and review of the literature. Ann Pharmacother. 1992 Jul-Aug;26(7-8):910-4. PMID: 1504397. [PubMed] [Read by QxMD]

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