Antibody-mediated reactions

Immunopathological Mechanisms of Allergic Reactions to Drugs I. Antibody-Mediated Reactions 

It is classical to divide allergic reactions into four types according to the classification of Gells and Coombs (1962). Whereas this classification may still appear valid as far as some of the initial triggering events of allergic or immunologically mediated reactions are concerned, it has become obvious that it represents a rather simplistic approach to the complex reality of immunologically mediated reactions in tissues. 

---

Anaphylactic reactions have very rarely occurred after intravenous cyclophosphamide (SED-8, 1126) (SEDA-17, 522) (36), and positive skin tests to the parent drug and/or 4-hydroxycyclophosphamide were found in several well-documented case reports (SEDA-19, 347). Although other mechanisms could be considered, a possible IgE antibody-mediated reaction was substantiated by the positivity of immediate skin tests to cyclophosphamide metabolites in five patients, and the recurrence of symptoms following intravenous or oral rechallenge in several of them (37). 

Platelet aggregation due to an antibody-mediated reaction has been suggested as a cause of streptokinase-enhanced coronary thrombosis in patients with a specific type of antistreptokinase antibodies (35). 

Lepirudin is used for treatment of patients who have thrombosis and thrombocytopenia as a result of an antibody-mediated reaction to heparin (see below). Antithrombin III is used for treatment of patients who need anticoagulation but are resistant to heparin because of a genetic deficiency in antithrombin III and also in some cases of acquired antithrombin III deficiency (eg, disseminated intravascular coagulation). 

D. Specific Inhibition of Antibody-Mediated Reactions to Drugs... 

Answers to questions 3, 4, 5, and 7 can go a long way toward helping to establish a firm diagnosis. In relation to points 4 and 5, information on the temporal sequence of events can provide essential information needed to help determine the mechanism of the reaction. Immediate, IgE-antibody-mediated reactions that can range from a simple rash to full-blown anaphylaxis generally occur from only a few minutes to 1 h after drug administration. Delayed or late reactions may occur from more than 1 h up to several days after... 

The chemically similar teicoplanin, not approved in the USA, is not inferior to vancomycin with regard to efficiency of treating grampositive infections. It shows a lower rate of adverse reactions, particularly nephrotoxicity and, as already discussed, is used as a substitute for vancomycin in red man syndrome. When hypersensitivity reactions do occur with teicoplanin they are generally of the delayed type, but there are a few documented cases of apparent IgE antibody-mediated reactions implicated, for example, by an immediate wheal and flare skin reaction to the drug or by teicoplanin-induced histamine release from a patient s basophils. Despite the chemical and pharmacological... 

Type I, IgE Antibody-Mediated Reactions to Sulfonamide Antimicrobials... 

Applicalion of this combination of tests offers the best chance of successfully investigating a hypersensitivity reaction to an NMBD during anesthesia, confirming or eliminating the occurrence of a true IgE antibody-mediated reaction and thus gaining insights into the underlying mechanism. 

---