Otolaryngology Book

Allergic Disorders

Throat Disease

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

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  1. Indication
    1. Skin test for horse serum sensitivity prior to use
    2. Many antitoxins and antivenins are from horse serum
  2. Consider alternatives to testing
    1. See Premedication for Allergy Prevention
  3. 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
  4. Technique
    1. 0.1 ml of 1:10 dilution of antitoxin intradermal
    2. Inject at forearm with 27 gauge
  5. 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
  6. 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.
ConceptsDisease or Syndrome (T047)
ICD9999.5
MSHD012713
EnglishIntoxication by serum, Protein sickness, Serum reaction, Serum Sickness, Serum Sicknesses, Transfusion reaction due to serum protein reaction
Spanishenfermedad del suero, intoxicacion por suero, reaccion a una transfusion por reaccion de las proteinas del suero, reaccion del suero
Parent ConceptsImmune Complex Diseases (C0020951), Hypersensitivity (C0020517), Multiple Organ Syndromes NEC (C0549513), Drug Eruptions (C0011609), Blood transfusion reaction (C0274435), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, CST, DXP, LCH, MSH, MTH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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