From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Rituximab is most likely to cause serum sickness in a child. Serum sickness is a type III hypersensitivity reaction that typically occurs 7-10 days after exposure to certain medications, particularly those containing foreign proteins. Rituximab, a chimeric monoclonal antibody used to treat certain autoimmune conditions and cancers, contains mouse protein components that can trigger this immune response. The human immune system recognizes these foreign proteins and forms immune complexes that deposit in tissues, activating complement and causing inflammation. This results in the classic symptoms of serum sickness: fever, rash, joint pain, and lymphadenopathy. While other medications like amoxicillin, vancomycin, and the flu vaccine can cause allergic reactions, rituximab carries a higher risk of serum sickness specifically due to its chimeric nature. Children receiving rituximab should be monitored closely for these symptoms, particularly during the week following administration. If serum sickness develops, treatment typically involves discontinuing the medication and providing supportive care with antihistamines, corticosteroids, and analgesics as needed.
Some key points to consider when evaluating the risk of serum sickness in children include:
- The mechanism of action of the medication and its potential to trigger an immune response
- The presence of foreign proteins in the medication, which can increase the risk of serum sickness
- The child's individual risk factors, such as a history of allergies or immune system disorders
- The importance of monitoring for symptoms of serum sickness, particularly during the week following administration of the medication
According to a study published in 1, drug hypersensitivity reactions, including serum sickness, can occur with various medications, including vancomycin, but rituximab is more likely to cause serum sickness due to its chimeric nature. Another study published in 2 found that vancomycin can cause diverse adverse reactions, including hypersensitivity reactions, but the risk of serum sickness is still higher with rituximab.
In terms of management, discontinuing the medication and providing supportive care is the primary approach to treating serum sickness. This may involve administering antihistamines, corticosteroids, and analgesics as needed to manage symptoms. It is essential to weigh the benefits and risks of each medication and to carefully monitor children for signs of serum sickness, particularly when administering medications with a higher risk of triggering this reaction, such as rituximab.