Serum sickness
Question:
11/6/2017
A 44 y F patient with SLE was recently diagnosed with serum sickness after repeated therapy with IVIG for ITP over > 2 years. How often does serum sickness occur after IVIG? How could this Dx be separated from active SLE which has many similar features? She also has chronic urticaria and angioedema and chronically low C3 and C4.
Answer:
A similar question was asked in the past on Ask the Expert and that response is below.
"There are several possible ways that you might administer immunoglobulin without causing serum sickness. They all depend on using smaller doses with or without increasing the frequency of administration. There is a brief mention of this technique in Clinical and Experimental Immunology 2004; 136(1):111-113. In this case, the dose was reduced to one-fifth of the original amount, and then, over the next several months, gradually increased until which time the patient tolerated a dose similar to that which originally produced the serum sickness symptoms.
One can do this by employing every three week intravenous infusions, or alternatively, try weekly administration of these smaller doses intravenously or subcutaneously. As in the case mentioned above, a gradual increase to the full therapeutic dose can be attempted over a three to five month period.
I am not aware that there is any distinct difference, in terms of the incidence of serum sickness, between intravenous and subcutaneous administration. However, since subcutaneous administration has an entirely different pharmacokinetic profile, it seems intuitive that it might be the better of the two choices for you.
Thank you again for your inquiry and we hope this response is helpful to you.
Sincerely,
Phil Lieberman, M.D. "
I looked on pubmed and could not find any articles that definitively defined the incidence of serum sickness with IVIG infusion. As you know medications are probably the most common cause of serum sickness and a review recent medication(s) use would be prudent in understanding the etiology of potential causes. It is not clear to me that any definitive test exists that would differentiate suspected serum sickness versus flair of SLE.
Andrew Murphy, MD, FAAAAI