Drug allergy: Pathogenesis
- Werner J Pichler, MD
Werner J Pichler, MD
- Professor of Clinical Immunology (Emeritus)
- University of Bern, Switzerland
A drug allergy is an adverse drug reaction that results from stimulation of the immune system by a medication. The pathogenesis of different types of drug-allergic reactions will be reviewed here. The classification and clinical features of drug-allergic reactions are discussed elsewhere. (See "Drug allergy: Classification and clinical features".)
INTERACTION OF DRUGS WITH THE IMMUNE SYSTEM
Drugs can elicit drug-specific immune responses in two ways (table 1):
●The drug may act as an antigen and elicit one of several classic immune responses.
●The drug may directly interact with immune receptors, and under certain circumstances, lead to activation of specific immune cells.
Drugs acting as antigens — Most medications are small molecular weight compounds with simple chemical structures which are not easily recognized by immune cells and are considered too small to interact with immune receptors with sufficient strength to activate T or B cells. Thus, most drugs are not effective antigens and are not immunogenic in their native state.
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- INTERACTION OF DRUGS WITH THE IMMUNE SYSTEM
- Drugs acting as antigens
- - Drugs as haptens
- - Reactive metabolites
- - Stimulation of an antibody response
- Pharmacologic interaction of drugs with immune receptors (the p-i concept)
- Overlap of mechanisms
- PATHOGENESIS OF SPECIFIC REACTION TYPES
- Type I (IgE-mediated)
- - Sensitization stage
- - Effector stage
- Type II (antibody-mediated cell destruction)
- Type III (immune complex deposition)
- Type IV (T cell-mediated)
- - Subdivisions of type IV