IgE-mediated drug hypersensitivity

Haptens or prohaptens can induce type I to IV immune reactions (Gell and Coombs classification)9 IgE-mediated drug hypersensitivity (type I), IgG-mediated... 

Himly M, Jahn-Schmid B, Pittertschatscher K, Bohle B, Grubmayr K, Ferreira F, Ebner H, Ebner C IgE-mediated immediate-type hypersensitivity to the pyrazolone drug propyphenazone. J Allergy Chn Immunol 2003 111 882-888. 

Types II and III Hypersensitivity. No simple animal models are currently available to assess Type II (antibody-mediated cytotoxicity) hypersensitivity reactions. IgE antibodies and immune complexes in the sera of exposed animals can be assayed using ELISA or RIA techniques that require the use of specific antibodies to the drug. 

Numerous compounds capable of antagonising the effects of histamine are available. The main therapeutic role of these drugs is in the treatment of allergic diseases involving IgE-mediated hypersensitivity, such as allergic rhinitis, hay fever, and urticaria (Table 15.2). The main Table 15.2 Clinical uses of Hlantagonists... 

Skin rashes due to podophyllotoxin derivatives may be hypersensitivity reactions and can be related to the drug itself or more commonly to the vehicles used. Dose-related, non-IgE-mediated hypersensitivity has been reported in 16 children receiving teniposide (118). Other published reports of hypersensitivity or anaphylactoid reactions to teniposide include degranulation of basophils (119,120), and eight anaphylactic reactions in children, all associated with the use of intravenous teniposide 150 mg/ m (121). 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

---