Does anybody know if there is a difference between serum sickness and allergy to a med?
I ask this bc I am about to start IV rocephin. About 10 years ago I was taken off of it because of what they thought was "serum sickness". So we thought I was allergic to penicillins and cephalosporins for many years, until recently. I have done 8 months on IM bicillin and then 2 months on omnicef, with no reaction.
I am concerned about being allergic to rocephin next week. Or developing serum sickness - if there is, in fact, any difference.
I am confused and worried.
[ 15. September 2006, 09:38 AM: Message edited by: luvdogs ]
Posted by bettyg (Member # 6147) on :
I have no knowledge on this subject so bringing this up for answers to your good question! Bettyg Posted by bcox (Member # 2604) on :
At first that is what my doc thought(serum sickness) AFter a few rounds down the road, it was determined I was having one heck of a die off.
Posted by luvdogs (Member # 9507) on :
I thought I would try and do more research on it - although it is hard to get a clear differentiation between serum sickness and allergic reaction (since it seems that SS IS an allergic reaction).
But if anybody has any info that might help apply to a real-life situation (as opposed to textbook info), that would be helpful as well.
This is what I came up with.
History: Primary serum sickness occurs 6-21 days after the administration of the inciting antigen. The onset may be more rapid with subsequent exposures to the same antigen, with symptoms occurring 1-4 days after exposure.
The classic clinical manifestations consist of fever, arthralgia, lymphadenopathy, and skin eruption. Pain, pruritus, and erythematous swelling at the injection site usually precede the onset of disease. Patients also may report joint and muscle aches, chest pain, and difficulty breathing. Physical: Physical examination may reveal cutaneous symptoms; fever; lymphadenopathy; arthritis or arthralgias; edema; and renal, cardiovascular, neurologic, or pulmonary manifestations.
Cutaneous symptoms (95%) may include the following: Urticaria Scarlatiniform rash Maculopapular or purpuric lesions Erythema multiforme Characteristic serpiginous, erythematous, and purpuric eruption at the junction of the palmar or plantar skin with the dorsolateral surface of the hands, feet, fingers, and toes Fever of 101-104�F is invariably present and may precede rash in 10-20% of cases. Lymphadenopathy (10-20%) may be generalized or may involve tenderness in the nodes that drain the injection site; splenomegaly may occur. Arthritis or arthralgias (10-50%) usually affect multiple large joints, but occasionally, small joints and joints of spine and temporomandibular joint may be inflamed. Myalgias or myositis also may occur. Edema may occur, particularly about the face and neck. Renal manifestations include proteinuria, microscopic hematuria, and oliguria; however, significant disease usually does not result. Cardiovascular findings may include myocardial and pericardial inflammation. Generalized vasculitis occurs rarely. Neurologic manifestations include peripheral neuropathy, brachial plexus neuritis, optic neuritis, cranial nerve palsies, Guillain-Barr� syndrome, and encephalomyelitis. Pulmonary manifestations, such as pleurisy, are rare. However, dyspnea and cyanosis are not uncommon.
Posted by ldfighter (Member # 9405) on :
I think they're two different things... maybe you can get allergy-tested for rocephin to make sure it will be ok.
Posted by seibertneurolyme (Member # 6416) on :
I think the important thing would be to know what symptoms you had previously. Rash, fever, whatever?
I would think the symptoms would be the same plus possibly some additional ones if you had a reaction again.
I know if this was me, I would want to start with a very low dose of the meds -- 25% or less of a normal dose to see what happens.
Hubby started IV Rocephin at 250mg 3 times a week and worked up from there. This was simply over concern regarding a herx as this was his first antibiotic.
Make sure you have an Epi pen available.
Bea Seibert
Posted by luvdogs (Member # 9507) on :
Thanks you guys. I wonder if we can be allergic to one abx but not another in the same family.
I will make sure that they are aware of my past history with this abx when I go in there on Wednesday. Maybe they will be up for the 3x week... At least they will be there with me the first time, monitoring everything. I think I will take antihistamines with it on a regular basis as well.
I just wish I could understand the whole serum sickness vs abx allergy thing. Everywhere I research does not clearly delineate anything and states that serum sickness is an allergy to the med... but then it is not the same as being allergic to med. It just doesn't make sense to me.
Posted by minimonkey (Member # 8693) on :
I just posted on this myself -- I think I am having a serum sickness reaction at the moment. I had this once before, years ago when I was on abx for a long time (for a UTI that wouldn't clear up.)
I can't quite figure out the difference between s.s. and an allergy either -- seems it is an immune response that is less immediate than the typical allergy, as it builds up over time.
Good luck with the IV!
I'm finding that taking benadryl is helping a little bit....
Posted by luvdogs (Member # 9507) on :
Thanks Minmonkey -
Yeah, i figure that I will take antihistamines regularly throughout - or at times when i feel like my immune sx is prone to being more allergic (like at all times).
I am going to ask my doc about the difference and i will be sure to post if he has any info that might explain more to us.
Are you getting the serum sickness on IV rocephin? I think sometimes it is hard to tell if it is serum sickness or herx.
I'll keep you posted with more info if I find it... I might not actually be meeting my my doc until one month from now - I don't know who is installing the PICC. ' Good luck to you too!
Posted by minimonkey (Member # 8693) on :
luvdogs --
I got serum sickness from Bicillin LA (intramuscular injections) -- at least I think that is what caused it. I've been on the Bicillin and also ketek for about 6 months now (with no problems up until now), and this nasty thing just started about a week and a half ago.... I'd rather forgotten that the same thing happened to me some years back.
Seems that Bicillin is a prime-offender for the serum sickness. Apparently it can take weeks or even months for this to happen, which is what makes it different from an allergy in the more common sense of the term -- this builds up over time. I'm sad, actually, as I was doing well on the med combination and now I have to make some changes.
I'm still miserable -- off all abx for the time being and takng benadryl and pain meds to help symptomatically -- my entire body itches like the devil, I broke out in a rash in several places, my lymph nodes are swollen, I'm nauseated and just generally feel exhausted and rather flu-ish.
I hope you do well with the rocephin -- I hear it is a very good drug for lots of folks.
Posted by bpeck (Member # 3235) on :
Luvdogs:
You've asked excellent questions- and you've posted pretty much the reply to your questions. Some antibiotics do have adverse effects- and of course not everyone reponds the same becuase there are differences in the enzymes system (in the liver) that metabolize some of these abx.
I know of only one person who got serum-sickness from (oral) antibiotics. And I know 2 people that were on home IV infusions of abx , and who's DOcs told them they could have an allergic reaction at any time - even to drugs you've taken without problems previously before.
I think if you have a good Dr.- one who knows what symptoms are typical to drug allergies (like rash, facial swelling) you should be OK.. but I think you're wise to research it yourself first.
Barb
Posted by lou (Member # 81) on :
I had what I finally decided was serum sickness after nearly three weeks of claforan. Had no problem with any other penicillin or cephalosporin, and serum sickness is listed as a possible side effect of this drug.
So, as an allergy ought to have affected my response to other drugs in this group, and many other people have had this same problem with claforan, it was fairly clear to me, at least, what it was.
One thing you did not include in your list of confusing look-alikes is herx. There are times when a herx can resemble an allergy. In fact, that is why non lyme docs frequently take patients off their meds....because they think the reaction is an allergy. But it is often a herx instead.
Posted by minimonkey (Member # 8693) on :
lou --
That is a good point -- I asked my llnp about whether this sounded like a herx or an allergy or what -- she said she sees this sometimes in folks who have been on major heavy-duty abx for a while, and that she doesn't think it is a herx in this case.
Posted by luvdogs (Member # 9507) on :
Lou -
Did they imply that every time that you go on claforan that you will develop serum sickness?
I wonder if our bodies stay very clean and detoxed while on the possibly offending abx, if that will make a difference in our body's (liver's) ability to break it down and not develop serum sickness.
My LLMDs since that time have thought that what I had many years ago was, in fact, a herx. I don't know if I told my current LLMD about my past experience with Rocephin.
I have a feeling that at different times we will be able to handle these meds.
I have had allergic reaction to sulfa in the past - the first time built up slowly and then next time I went on it, it was anaphylaxis. The "serum sickness" felt very different from the first time I was developing an allergy to the sulfa. Nonethless, I am glad that I will be under doctor's supervision when I start the rocephin on Wednesday.
Minmonkey - are you coming around? When can you go back on abx? I have been off since last monday and am beginning to get pretty messed up.
Posted by minimonkey (Member # 8693) on :
luvdogs--
I think I'm starting to recover -- very hard at the moment to tell what is what. I see my LLNP this week, so I'll ask what to do next.
I have been detoxing like crazy, supplementing, etc. all along, and that doesn't seem to have prevented this.
I have a sulfa allergy too -- only took that once, years and more years ago. Pretty clearly an allergy, I think.
The serum-sickness type reaction I had some years back got increasingly worse with time, and continued after switching abx. It culminated with the early stages of anaphylaxis for me, too -- that was on Keflex, so I was told never ever to take a cephalosporin again. The reaction started on amoxicillin, as I dimly recall, and got worse throught a course or two of biaxin -- what possessed the docs to put me on Keflex I'll never know -- I think they thought it was all in my head. That is what they thought about the UTI as well, and they told me so... ended me in the ER when it progressed to my kidneys. I had lyme even then (undxed) so I suppose it could have been a herx -- but I don't care to risk repeating the anaphylaxis part.
Anyhow, for years, the only abx I would take was doxycycline, as I didn't have a bad reaction to it. I've since taken others and been okay with them.
I was quite surprised at how well I tolerated the high doses of abx for the past 8 months.... sigh.
I definitely don't want to go back on abx prematurely -- this is truly a miserable experience. May try a run of good old doxy if LLNP okays that, though it made me herx like crazy the last time I took it.
Isn't this fun????
Posted by lou (Member # 81) on :
Luvdogs, no one has implied anything about further claforan treatments. At the time my medical supervision was pretty lax. The bloomin' allergist who checked me ahead of time for an allergy did not return my phone call when this hit. So, I had to figure it out by myself.
As far as not taking other cephalosporins, this was not true for me afterwards. I went on claforan first, then rocephin later. No serum sickness with rocephin. And I would not want a repeat of what happened on claforan and would not ever use that particular drug again.
Posted by luvdogs (Member # 9507) on :
Minimonkey - I like the "I am going to get well, no matter what it takes". I can't believe your experiences. It must have been very nervewrecking for you. But I am glad you had doxy at least.
I think you will pull through this soon. I am crossing my fingers for you.
Well, I am going to sedate myself and antihistamine myself and get ready for tomorrow. There is no point in being nervous.
Remember - we will get well no matter what it takes! It felt good to write that Posted by minimonkey (Member # 8693) on :
luvdogs --
Thanks for the kind words of support -- like so many others here, I've had a host of medical nightmares for most of my life -- and my experiences look like child's play compared to some folks' tales of woe!!
I saw my LLNP today, and she thinks that I actually have drug-induced hepatits, not serum sickness. I did a bit of reading, and by gum, I think she's right. (She generally *is* right -- I adore my LLNP). We'll have my lab results tomorrow.
Scary stuff. It hit fast and hard, after many months of completely normal liver tests. I started thinking "liver" yesterday, myself, when I noticed that my stool was very light in color -- a warning sign of liver trouble.
Turns out that the itchiness, the nausea/vomiting, loss of appetite, abdominal pain, low grade fever, etc. are also all signs of drug-induced hepatitis. Since they also all fit with serum sickness too, I stopped there and didn't do enough reserach it seems.
Anyhow, I've been off the abx for over a week, but still having a lot of the sx --still had a fever as of this morning, and am itching as I write.
It'll very likely resolve on its own, but a break from the abx and other liver stressing drugs is definitely in order. I'm hoping it isn't anything too serious or long term -- trying to just remain zen about it until I have more info.
I've been on a lot of heavy duty meds for quite a long time, so I'm not that surprised that this happened. In any case, this is a good reminder that we shouldn't write off new and different symptoms on the assumption that it is a herx... it could be a sign of other trouble.
I'm rather irritated at myself for not catching on to this sooner, seeing as how I have been on ketek for quite a while, and I know what it can do to the liver.
Anyhow, hoping I'm on the mend -- taking good liver support, trying to take it easy (not my strong suit) and also trying not to worry unless I have a good reason to do so.
Hope you get through the rocephin with no problems whatsoever!!
Posted by luvdogs (Member # 9507) on :
Hi minmonkey...
Geeezzzz that sucks! I hope you are feeling a little bit better today. I did some research on it and it sounds like chances for recovery are quite good. I hope that's not what it is, but even if, I think you can pull through this one too.
Do you have any yellowness about you? it sounds like you probably don't, and I would assume that's a good sign. It sounds like the worst and irreversible cases come from swallowing poison type things.
It sounds like you have a great doc. What part of cali are you in?
Me, I made it through yesterday with no problems. I am taking it one d ay at a time and saying my prayers. As I am sitting there with the rocephin dripping into me, the doc says "see, you are not allergic! You would not have made it this far if you were". That was very reassuring.
I guess there is a secondary type of allergic reaction which could, in fact, be the serum sickness. it is an IgE(?) or IgG reaction. But many can ride the strom of that with anithistamines etc and let the storm pass.
it was hard to get real straight answers about the serum sickness. It seems that they think that is most often the secondary reaction or a herx, but they don't seem too worried about it. Still vagueness, no matter how hard I try
Please start to come around. Give your liver and big hug and tell it that we said it has to get better now! Keep me updated.. PM or here. I think it is good to do this here though (or on your new post), cause then others learn about it.
Best wishes from me and my dogs and everybody at Lymenet I am sure,
Sara
Posted by Marnie (Member # 773) on :
Either way...far too acidic.
Metabolic acidosis.
You might want to discuss activated charcoal with your doctor.
It pulls most drugs out of the body.
It does not impact lithium or ethanol, unfortunately.
Your liver is already taking a HUGE hit.
It is called "toxic hepatitis". I know, because this happened to my father years ago.
A very acidic system is hard on the liver which many drugs have to be "processed thru", but a lot of acids/negative charges also can harm delicate kidney cells too which are trying desperately to manage the acid-base (pH) balance.
The kidneys can be permanently damaged. Be careful.
Be sure you are drinking lots of good water...even Pure Life by Nestle is okay. Wally Mart carries it.
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