Paediatric serum sickness-like reaction: A 10-year retrospective cohort study

Abstract

Background Serum sickness-like reaction (SSLR) is an acute inflammatory condition affecting predominantly children. The pathophysiology remains unclear, but drugs are considered the main trigger. Objective The aim of this study was to describe the clinical and laboratory features, triggers, and treatment modalities in children diagnosed with SSLR. Methods We conducted a 10-year retrospective cohort study including all paediatric patients (0 to 18 years old) with query SSLR referred to the Adverse Drug Reactions Clinic at the Children’s Hospital of Western Ontario. Diagnostic criteria included acute skin rash plus joint inflammation with or without fever. Results We included 83 patients (47 females). Age ranged from 11 months to 12 years (mean 3.2 years). Amoxicillin was the trigger in 82.7% of patients. The mean time between the exposure to the triggering drug and the development of the symptoms was 8.5 days. Urticaria-like and Erythema multiforme-like lesions were present in 35% and 38.5% of the cases, respectively. Joint inflammation affecting hands/feet was present in 60%. Pruritus, lip/eye swelling, and fever were reported in 33, 31, and 45% of patients, respectively. The lymphocyte toxicity assay (LTA) showed incremental T-cell toxicity in 32 of 34 patients. Children that received treatment with antihistamines/nonsteroidal anti-inflammatory drugs (NSAIDs) plus oral steroids had a mean recovery time shorter than those treated only with antihistamines/NSAIDs (6 versus 8 days; P=0.09). Conclusions In our study, SSLR was mostly triggered by amoxicillin and had a mean time presentation of 8.5 days. Further prospective and well-conducted studies are needed.

The role of in vitro testing in pharmacovigilance for ß-lactam-induced serum sickness-like reaction: A pilot study

“…Any ambiguity in the diagnosis was confirmed by a third clinician (MJR). The general criteria for diagnosis include development of skin rash and joint inflammation with or without fever after exposure to the culprit drug ( De Schryver and Ben-Shoshan, 2015 ; Del Pozzo-Magana et al, 2021 ). The inclusion criteria of this group include: 1) Having a history of SSLR related to the administration of a ß-lactam antibiotics (penicillins or cephalosporins); 2) symptoms developed are highly suggestive of SSLR and should include skin rash and joints involvements; 3) the patient consents to participate in the study and provides a sufficient blood sample.…”

“…This type of reactions can also develop as a result of vaccine administration including recent cases of SSLR to inactivated COVID-19 vaccine ( Chung et al, 2021 ; Chaijaras et al, 2022 ). The condition is defined by sudden appearance of skin rash (usually urticaria-like) and arthritis usually manifested 1–3 weeks after drug exposure, which can be accompanied by fever, lymphadenopathy, eosinophilia, and rarely renal involvement ( Del Pozzo-Magana et al, 2021 ). It is uncommonly seen in clinical practice, but its incidence appears to be on the rise since the introduction of biologic drugs ( Finger and Scheinberg, 2007 ; Khan, 2016 ).…”

“…In a 10-year retrospective cohort study we found that SSLR represent 15.4% of all patients with cutaneous ADRs referred to our clinic, 0.02% of all cause of consult, and 0.9% of all sudden skin rashes seen in the our institution pediatric emergency department. The most commonly implicated drugs were ß-lactam antibiotics including amoxicillin (87%) and cephalosporins (8.5%) ( Del Pozzo-Magana et al, 2021 ). Type B ADRs also include “pseudoallergy”, which is non-immune-mediated.…”

Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

“…Клиническая картина данного состояния идентична истинной сывороточной болезни, однако последняя обусловлена развити-ем аллергической реакции типа III [2]. Патогенез SSLR остается малоизученным, а само заболевание ассоциировано с реакцией на лекарственные препараты [3], вакцины [4], вирусные и бактериальные инфекции [5]. Заболевание характеризуется специфическими кольцевидными элементами, лихорадкой, полиартритом, полиартралгиями и благоприятным прогнозом с самостоятельным разрешением высыпаний при устранении действия провоцирующего фактора [6,7].…”

“…Распространенность SSLR неизвестна. Заболевание редко диагностируется, так как часто ошибочно принимается за другие дерматозы (крапивница, многоформная экссудативная эритема, вирусные экзантемы, лекарственные реакции), которым присущи кольцевидные и полициклические высыпания [3]. Вместе с тем, для SSLR характерны внезапное появление кожной сыпи и поражение суставов, с лихорадкой или без нее, которым предшествуют прием (чаще всего) лекарственных средств [10], инфекция [5] или вакцинации [11].…”