Potential of Antibody Therapy for Respiratory Virus Infections
Sunit K. Singh in Human Respiratory Viral Infections, 2014
On the other hand, passive immunotherapy involves the direct transfer of pre-made antibodies and has been used in both disease prevention and treatment. Unlike vaccination, the application of pre-made antibodies could also be particularly useful for protecting immune-compromised individuals who may not respond to vaccination. Passive immunotherapy was first described by von Behring and Kitasato in the early 1890s [6] and was used to treat many infectious diseases until the early 1930s. This initial form of passive immunotherapy was known as serum therapy as it involved the use of crude antiserum preparations obtained from immunized animals to confer protection in humans. As such, essentially all patients developed serum sickness as they mounted an immune response against foreign proteins present in the animal antisera [7]. Convalescent sera from humans as a source of polyclonal antibodies reflect the natural immune response in totality and reduce the incidence of serum sickness; however, its production is limited to the availability of immune donors and is highly variable in terms of antibody specificity and quantity. This leads to significant batch-to-batch variation and variable pharmacokinetics [8].
Benzylpenicillin (Penicillin G)
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Cytotoxic reactionsare defined as Type BII- and BIII-mediated reactions (Pichler, 2007), which can occur in approximately 2% of patients treated with Pen G (Polk, 1982). While these were previously thought to appear 7–10 days after primary administration of Pen G, they can infact be accelerated and occur on rare occasions within 5–72 hours of administration (Pichler, 2007). In the case of serum sickness, circulating immune complexes are produced after exposure to Pen G, the formation of which is possible because intravascular antigen is still present when antibody is first produced (Parker, 1975). Serum sickness is characterized by fever, malaise, urticaria, joint pains, lymphadenopathy, and occasionally angioneurotic edema. Erythema nodosum is a less common manifestation. Drug fever may be the sole manifestation of Pen G–induced serum sickness (Young et al., 1982a). However, some authors consider that the mechanisms by which drugs induce fever have not been well delineated and that this reaction may not have an allergic basis (Mackowiak and Le Maistre, 1987). Serum sickness is usually not serious, and it subsides when Pen G is withdrawn. Antihistamines are helpful, but in severe cases corticosteroids are necessary.
Acute erythematous rash on the trunk and limbs
Richard Ashton, Barbara Leppard in Differential Diagnosis in Dermatology, 2021
Acute urticaria may be caused by: A type 1 allergic response, which occurs within a few minutes of contact with an allergen either on the skin (e.g. nettle rash, latex allergy see p. 299) or ingested (e.g. strawberries or penicillin). The rash disappears spontaneously within an hour. Contact with the same allergen again will result in a further episode.Direct release of histamine from mast cells by aspirin, codeine or opiates. IgE is not involved. This is the commonest cause of infrequent acute episodes of urticaria, occurring when a patient takes aspirin for a cold or headache.Drugs which can cause serum sickness (an immune complex reaction). Urticaria, arthralgia, fever and lymphadenopathy are the hall marks of this. It may be caused by the following drugs:PenicillinPhenothiazinesThiazide diureticsNitrofurantoinThiouracil
Incidence of serum sickness following Indian polyvalent antivenom therapy in a cohort of snake-envenomed patients in rural Sri Lanka
Published in Clinical Toxicology, 2023
Subodha Waiddyanatha, Anjana Silva, Supun Wedasingha, Sisira Siribaddana, Geoffrey K. Isbister
The definition and diagnostic criteria for serum sickness have not been validated to date, which is the most likely reason for the vast difference in the rates of serum sickness reported between studies − 4% to 56% [8,14]. Serum sickness is defined as an immune-complex-mediated hypersensitivity reaction that classically presents with fever, rash, polyarthritis, or polyarthralgia [22]. Most studies have used a combination of these clinical features as part of their definition, including the present study here and an Australian study [14]. Ruha et al. [29] reported 7% of patients having serum sickness, based on rash, pruritis, fever, myalgia, and arthralgia for the diagnosis. Lavonas et al. [30] used the same criteria, but included the presence of vomiting, and reported 4.9% having serum sickness. Bush et al. [31] used fever, arthralgia, and pruritus as diagnostic criteria for serum sickness, and reported 6.7% of patients developing serum sickness, after Crotalidae polyvalent immune Fab (ovine) antivenom for Southern Pacific rattlesnake (Crotalus helleri) envenomation. LoVecchio et al. [15] reported the highest rate of serum sickness in 56% of cases following the administration of crotalid Wyeth polyvalent antivenom (equine, whole IgG), for rattlesnake envenomation. However, LoVecchio et al. defined serum sickness as the development of an unexplained rash within 3 to 21 days of antivenom administration, likely increasing the number of patients meeting the definition of serum sickness [15].
Urticaria multiforme in a 2-year-old girl
Published in Baylor University Medical Center Proceedings, 2019
Meredith Gavin, Leigha Sharp, Cloyce L. Stetson
First termed “acute annular urticaria” in 1997 due to the characteristic polycyclic lesion, the name “urticaria multiforme” was coined in 2007 by Shah et al to differentiate this unique urticarial variant.3 It is commonly misdiagnosed as erythema multiforme due to the impressive annular erythematous plaques in a febrile patient or a serum sickness–like reaction due to the presence of acral angioedema. The lesions of erythema multiforme are true target lesions with skin necrosis, blistering, and significant mucus membrane involvement, all of which are not present in urticaria multiforme. Serum sickness–like reactions can be differentiated by their significant systemic symptoms, including high fevers, arthralgias, and lymphadenopathy. The fleeting nature of the lesions, dermatographism, and favorable rapid response to antihistamines help to confirm the diagnosis of urticaria multiforme.2 Due to the difference in prognoses, workup, and treatment between these three conditions, our case seeks to highlight the importance of differentiating urticaria multiforme in order to prevent unnecessary biopsies and laboratory tests as well as establish an appropriate treatment plan and provide reassurance regarding the benign nature of this condition.
The democratization of de-labeling: a review of direct oral challenge in adults with low-risk penicillin allergy
Published in Expert Review of Anti-infective Therapy, 2020
Morgan Thomas Rose, Monica Slavin, Jason Trubiano
In a prospective case series over 12 months, Li et al. identified 70 adult inpatients with low-risk penicillin AALs at an Australian center with an infective diagnosis requiring beta-lactam therapy. Low-risk allergy phenotypes were defined as (I)Type A ADRs, and (II) all immune-mediated reactions excluding – (i) anaphylaxis (within 10 years), (ii) hemolytic anemia, (iii) serum sickness, and (iv) severe cutaneous adverse reactions (SCAR). Sixty-three proceeded to 3-stage graded oral challenge with amoxicillin (2.5 mg/25 mg/250 mg-30 min interval, 2 h total observation post-last dose) and completed a 3-day course of the target dose. Of these, 56 had described a suspected immune-mediated allergy history. Fifty-four of 56 completed the challenge without complication, 2 (3.6%) described delayed rash without systemic symptoms after 3 and 4 days of beta-lactam therapy, respectively. In comparison to historical controls, statistically significant reductions were seen in the length of stay, cost of antimicrobials, and overall admission costs, in addition to a reduction in the rate of readmission [48].
Related Knowledge Centers
- Adverse Drug Reaction
- Animal
- Antiserum
- Fever
- Rash
- Type III Hypersensitivity
- Lymphadenopathy
- Arthralgia
- Hypersensitivity
- Type III Hypersensitivity
- Serum Sickness-Like Reaction