Urticaria of the serum disease typeL50.0
DefinitionThis section has been translated automatically.
Urticaria in serum disease ( allergy, type III reaction) with fever, lymphadenopathy, arthritis, nephritis, angioedema.
EtiopathogenesisThis section has been translated automatically.
Presence of soluble antigen-antibody complexes (type III reaction). Trigger: Early injection of foreign sera and immunoglobulins. Today: antibiotics, sulphonamides, antiepileptics, X-ray contrast medium, acetylsalicylic acid.
General therapyThis section has been translated automatically.
Removal of the triggering agent. Antihistamines are mostly ineffective. S.a.u. Urticaria, acute.
Internal therapyThis section has been translated automatically.
- Initial exposure: At first exposure, the non-appearance interval is 5-7 days until the first symptoms appear. Glucocorticoids in medium to high dosages such as prednisolone (e.g. Solu Decortin H) 60-100 mg/day or dexamethasone (e.g. Fortecortin Tbl.) 12-16 mg/day. Depending on the clinic, slow dose reduction and balancing.
- Repeated exposure: Immediate reaction with shock and fulminant course. Raise the patient's legs. Large-lumen i.v. access, possibly central venous valve regimen, rapid volume substitution. Dilute adrenalin (e.g. suprarenin) 1:1000 with 0.9% NaCl solution 1:10 and draw up 10 ml (for pre-filled syringes, no dilution is usually necessary). Slow i.v. injection of 0.3-0.5 ml (-1 ml), repeat after 10 min. Intubation if necessary and possible, otherwise coniotomy or tracheotomy, see shock, more anaphylactic. Glucocorticoids high dosage i.v.: Prednisolone 250-500 mg i.v., if necessary higher dosage and after clinical findings also repeated administration. Depending on the clinical findings, gradual dose reduction and later change to an oral preparation: methylprednisolone (e.g. Urbason) or prednisolone.
The use of 10 ml calcium gluconate 10% i.v. is controversial, there is no definite indication.
Heat withdrawal at temperature > 39 °C: calf compress, ice bag in the groin.
LiteratureThis section has been translated automatically.
- King B et al (2003) Adverse skin and joint reactions associated with oral antibiotics in children: The role of cefaclor in serum sickness-like reactions. J Paediatr Child Health 39: 677-681
- Lowery N et al (1994) Serum sickness-like reactions associated with cefprozil therapy. J Pediatr 125: 325-328
- Nigen S et al (2003) Drug eruptions: approaching the diagnosis of drug-induced skin diseases. J Drugs Dermatol 2: 278-299
- Parra FM et al (1994) Serum sickness-like illness associated with rifampicin. Ann Allergy 73: 123-125
- Phillips EJ et al (2003) Serum sickness-like reaction associated with clopidogrel. Br J Clin Pharmacol 56: 583
- Platt et al (1988) Serum sickness-like reactions to amoxicillin, cefaclor, cephalexin and trimethoprim-sulfamethoxazole. J Infect Dis 158: 474-477
- Puyana J et al (1990) Serum sickness-like syndrome associated with minocycline therapy. Allergy 45: 313-315
- Ralph ED et al (2003) Serum sickness-like reaction possibly associated with meropenem use. Clin Infect Dis 36: E149-151