Penicillin immune response

Whilst this may explain potentially explain many cases, this does not represent the full mechanism which is undoubtedly more complex as not all reactions appear to be immunological. For example, paracetamol is known to form reactive intermediates but yet is not involved in idiosyncratic reactions. Indeed, with some notable exceptions such as the penicillins, many drugs involved in idiosyncratic reactions do not mediate their toxicity through a immune response. 

Lack of previous exposure is not the same as lack of history of previous exposure, and first dose reactions are among the most dramatic. Exposure is not necessarily medical, e.g. penicillins may occur in dairy products following treatment of mastitis in cows (despite laws to prevent this), and penicillin antibodies are commonly present in those who deny ever having received the drug. Immune responses to drugs may be harmful (allergy) or harmless the fact that antibodies are produced does not mean a patient will necessarily respond to re-exposure with dinical manifestations most of the UK population has antibodies to penicillins but, fortunately, comparatively few react clinically to penicillin administration. 

The adverse effects of early penicillin use consisted almost exclusively of anaphylaxis. This stimulated extensive research into the immune responses associated with penicillin and made penicUhn the most prominent model for immune reactions to drugs. 

Levine BB, Redmond AP, Fellner MJ, Voss HE, Levytska V. Penicillin allergy and the heterogenous immune responses of man to benzylpenicillin. J Clin Invest I966 45(I2) I895-906. 

Hapten-dependent antibody Drag (hapten) links covalcmtly to monbiane protein and induces a drag-specific immune response Penicillin, cephalosporin antibiotics ... 

Solley O, Gleich J, Jordan RE, Schroeter AL (1976) The late phase of the immediate wheal-and-flare skin reaction. Its dependence upon IgE antibodies. J Clin Invest 58 408 Spark RP (1971) Fatal anaphylaxis due to oral penicillin. Clin Pathol 56 407 Spengler H, de Week AL (1977) Evaluation of genetic control of the immune response to penicillin in man. Monogr Allergy 11 116... 

The fact that penicillins may induce an immune response and the formation of penicillin-specific antibodies in man and in experimental animals was recognized soon after their introduction into therapy in 1943 (Lyons 1943 Rostenberg and Welch 1945 Wilensky 1946 Chu and Cutting 1946 Brown 1948). In the early... 

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