Serum sickness-like reaction

Shiari R, et al. Clinical and laboratory profile of serum sickness-like reaction in children. Ind J Rheumatol. 2011 Dec; 6(4): 173-177.

“This study aims to determine the aetiological factors of serum sickness-like reaction, influence of age and sex, clinical manifestation, and lab findings of this disease during the time period between April 2009 and September 2010 in a university-affiliated children’s hospital.”

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Tolpinrud WL, et al. Serum sickness-like reaction: histopathology and case report. J Am Acad Dermatol. 2011 Sep;65(3):e83-5.

“The diagnosis of SSLR is frequently based on clinical features. However, in those instances when a skin biopsy is necessary, it is important to know the histopathologic features that support a diagnosis of SSLR. Our results add to the small number of previous reports showing histopathology that appears to be in the spectrum of urticaria. This is distinct from the vasculitis seen in acute hemorrhagic edema of infancy that is in the clinical differential diagnosis of SSLR and is important to rule out because of the possibility of internal organ involvement. [5]”

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O’Keeffe DT, Cooke R. Serum sickness like reaction in an 11-year-old boy. Ir J Med Sci. 2011 Jun;180(2):605-6.

“Serum sickness like reactions are characterized by fever, pruritis, urticaria, and arthralgias that usually begin 1–3 weeks after drug exposure [3]. Laboratory studies may show leukocytosis, elevated ESR, and proteinuria or haematuria. Treatment includes withdrawal of the inciting agent and symptomatic treatment with antihistamines, corticosteroids, and/or antipyretics [4]. Kunnamo et al. [5] estimated that the annual incidence of drug-induced SSLR with acute arthritis and detectable immune complexes was 4.7 cases per 100,000 in children younger than 16 years. Vial et al. [6] suggested an incidence of 0.024–0.2% of SSLR per drug course of cefaclor. The majority of these reactions occurred in children younger than 5 years of age. It should be noted that if the triggering agent is identified, future avoidance of this agent is mandatory because recurrence of SSLR can be more rapid and severe with subsequent exposure [2].”

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Patel S, Mancini AJ. Serum sickness-like reaction in children: a retrospective review. J Am Acad Dermatol 2009; 60 (3 Suppl 1): AB6.

“Antibiotic-associated SSLR is still an observed reaction pattern in the
post-cefaclor era. SSLR is highly associated with antibiotic exposure, with amoxicillin
and amoxicillin with clavulanic acid being the most commonly associated in
this review. Cephalosporins were associated in only 16% of patients in whom a
single antibiotic was received. This review supports previous data with regard to age
and timing of onset and presentation pattern of SSLR.”

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Yerushalmi J, Zvulunov A, Halevy S. Serum sickness-like reactions. Cutis. 2002 May; 69(5):395-7.

“SSLR describes drug reactions with a broad dermatologic spectrum accompanying fever and arthralgia/arthritis. Palpable purpura (vasculitis), urticarial lesions, and erythema multiforme–like lesions all have been reported in SSLR. Possibly, these different presentations may reflect different pathogenesis. Thus, further definition and study of this entity are needed.”

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More PubMed results on SSLRs.

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