Delayed type cutaneous

Delayed-type cutaneous reactions to clindamycin include pruritus, exanthematous rash, generalized maculopapular exanthema, erythroderma, generalized exanthematous pustulosis, and Stevens-Johnson syndrome. 

Ingested arsenic localizes to the skin [2, 7], where it may alter cutaneous immune responses. The delayed type hypersensitivity (DTH) response to 2,4-dinitrochlorobenzene (DNCB) was suppressed in Bowen s disease patients [8], Langerhans cells (LC) in skin lesions and perilesioned skin from arsenic-induced Bowen s disease and carcinomas were reduced in number and were morphologically altered, having a notable loss of dendrites [9], These data suggest that chronic exposure to arsenic in drinking water may... 

Inhibition of T cell recruitment and cutaneous delayed-type hypersensitivity-induced inflammation with antibodies to monocyte chemoattractant protein-1. Am. J. Path. 148, 855-864. 

Organomercurials have been a common cause of allergic contact dermatitis or rash (22) and even exfoliative dermatitis has been described (23). Some reagents for intra-cutaneous testing (tuberculin, etc.) may contain thiomersal, which can cause sensitization and thus elicit false-positive delayed-type skin reactions. Mercury compounds inhibit most lymphocyte functions (SEDA-21, 240). An early indicator of an immunological response to mercury exposure, for example in occupational medicine, appears to be a change in the lymphocyte count with a differential increase in T helper cells and a rise in the T helper/T suppressor ratio (24). 

Platt JL, Grant BW, Eddy AA, Michael AE Immune cell populations in cutaneous delayed-type hypersensitivity. J Exp Med 1983 158 1227-1242. 

Mathieu A, DiPadua D, Mills J, Kahan B (1974) Experimental immunity to a metabolite of halothane and fluroxene cutaneous delayed-type hypersensitivity. Anesthesiology 40 385-390... 

Guinea pigs were immunized repeatedly with rifampicin in complete Freund s adjuvant and skin reactions after challenge were studied (Dukor et al. 1973). There was evidence of allergic reactions of the immediate as well as of the delayed type. However, antibodies were not measured by passive cutaneous anaphylaxis or any other immunologic method. Therefore, the skin reactions observed 4 h after challenge could well have masked an incipient type of delayed hypersensitivity reaction (Dewdney 1977). Hence, these experiments do not establish unequivocally the im-munogenicity of rifampicin. 

Rand et al. (22) addressed the role of MCP-1 in a rat model of a cutaneous delayed-type hypersensitivity reaction. They observed MCP-1 expression by infiltrating neutrophils at early time points (4-8 h) following intradermal challenge and by epidermal and epithelial cells at later time points, with maximum expression at 24 h. Macrophage and T-cell recruitment peaked 2-3 d after challenge, and anti-MCP-1 antibodies inhibited the recruitment of T cells into the inflamed skin in a dose-dependent manner. In contrast, macrophage recruitment was inhibited only at the highest antibody dose. 

Rand, M. L., Warren, J. S., Mansour, M. K., Newman, W., and Ringler, D. J. (1996) Inhibition of T cell recruitment and cutaneous delayed-type hypersensitivity-induced inflammation with antibodies to monocyte chemoattractant protein-1. Am. J. Pathol. 148,855-864. 

Allergy a hypersensitivity of the immune apparatus s pathological immune reaction induced either by antibodies (immediate hypersensitivity) or by lymphoid cells (delayed type A.). Unlike the delayed type, immediate hypersensitivity can be passively transmitted in the serum. Symptoms of immediate hy-peisensitivity begin shortly after contact and decay rapidly, but delayed type symptoms do not attain a maximum for 24-48 hours then decline slowly over days or weeks Examples of immediate type A. are anaphylaxis the Arthus reaction and serum sickness. The best known A., anaphylaxia, can occur as a local (cutaneous) reaction (e.g. a rash with blisters) or as a systemic reaction (anaphylactic shock). Asthma, hay fever and nettle rashes are also examples of local anaphylactic reactions which are induced by reagins (see Immunoglobulins IgE). Only primates can be sensitized by injection with human reagins. An example of delayed type A. is the tuberculin reaction, which is based on a cellular immune response. 

In combination with acids, toxic chloride gas arises in combination with formaldehyde, carcinogenic reaction-products will be formed. Cutaneous intolerance to hypochlorite may become manifest through immediate-type and delayed-type responses, and could lead to systemic reactions in patients previously sensitized by cutaneous contact (Hostynek 1989). 

In addition to skin-prick testing, Wilkinson and Beck used ammoniated latex for diagnosing delayed-type allergy to NRL. Of 822 patients, 16 (1.9%) demonstrated positive cutaneous reactions to latex. Six were SPT-positive, five were both SPT and patch-test positive and five were only patch-test positive. Patch testing with latex will be an important methodology in the future in diagnosing delayed-type eczematous reactions to NRL, but proper test materials not containing rubber chemicals are first needed (Wilkinson and Beck 1996). 

Tse Y, Cooper KD. Cutaneous dermal Ia+ cells are capable of initiating delayed type hypersensitivity responses. J Invest Dermatol. 1990 94 267-72. 

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