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Skin Test for Horse Serum SensitivityAka: Horse Serum Sensitivity, Serum Sickness

Indication
1. Skin test for horse serum sensitivity prior to use
2. Many antitoxins and antivenins are from horse serum
Consider alternatives to testing
1. See Premedication for Allergy Prevention
Efficacy: Controversial in Snake Antivenin use
1. Advantages to performing skin test prior to antivenin
  1. Possible medicolegal protection only
2. Disadvantages to skin test prior to antitoxin
  1. Delays treatment (antitoxin administration)
  2. High false-positive rate: 33%
  3. High false-negative rate: 10 to 36%
  4. Has resulted in Anaphylaxis in some patients
3. References
  1. Jurkovich (1998) J Trauma 28:1032
Technique
1. 0.1 ml of 1:10 dilution of antitoxin intradermal
2. Inject at forearm with 27 gauge
Observe for Allergic Reaction for 20 minutes
1. Local reaction
  1. Hyperemic areola at injection site > 0.5 cm
2. Systemic reaction
  1. Fever, chills
  2. Hypotension with decrease Blood Pressure >20 mmHg
  3. Skin rash
  4. Respiratory difficulty
  5. Nausea, Vomiting
  6. Generalized itching
Interpretation: If any signs of reaction
1. Suggests horse serum sensitivity
2. Do not use antitoxin

Serum sickness (disorder) (C0036830)
Definition (MSH)	Immune complex disease caused by the administration of foreign serum or serum proteins and characterized by fever, lymphadenopathy, arthralgia, and urticaria. When they are complexed to protein carriers, some drugs can also cause serum sickness when they act as haptens inducing antibody responses.
Definition (CSP)	immune complex disease caused by the administration of foreign serum or serum proteins and characterized by fever, lymphadenopathy, arthralgia, and urticaria; when they are complexed to protein carriers, some drugs can also cause serum sickness when they act as haptens inducing antibody responses.
Concepts	Disease or Syndrome (T047)
ICD9	999.5
English	Intoxication by serum, Protein sickness, Serum reaction, Serum Sickness, Serum Sicknesses, Transfusion reaction due to serum protein reaction
Spanish	enfermedad del suero, intoxicaciÃ³n por suero, intoxicacion por suero, reacciÃ³n a una transfusiÃ³n por reacciÃ³n de las proteÃnas del suero, reacciÃ³n del suero, reaccion a una transfusion por reaccion de las proteinas del suero, reaccion del suero
Credits	Derived from the NIH UMLS (Unified Medical Language System)