Drug Hypersensitivity Reactions: Classification and Pathogenesis (Part 1)

Czech version

Authors: J. Nemšovská
Authors‘ workplace: Dermatovenerologická klinika LF UK a UNB, Bratislava, prednostka prof. MUDr. Mária Šimaljaková, PhD., MPH, MHA
Published in: Čes-slov Derm, 94, 2019, No. 3, p. 99-106
Category: Reviews (Continuing Medical Education)

Overview

Drug hypersensitivity reactions (DHRs) represent 15% of all adverse drug reactions. Various mechanisms, resulting in miscellaneous clinical pictures, are involved in the genesis of these reactions. DHRs can be classified by different classifications based e. g. on the timing of the symptoms appearance or types of immune mechanisms.

Currently increasingly used classification is based on the mode of action of drugs leading to immune/inflammatory cell stimulation. We recognize three kinds of DHRs according to the mechanism of cell stimmulation: allergic reaction mediated by hapten-carrier complex, reaction triggered by pharmacological interaction of the drug with immune receptors and pseudo-allergic reaction, in which drug stimulates or inhibits receptors or enzymes of inflammatory cells.

None of these classifications is ideal and is not able to explain or to link to the nature of the disease, pathomechanisms, clinical pictures, cross-reactivity or optimal treatments, because the interactions between the drug and the immune system are far more complex than previously anticipated. Except for the classification and pathogenesis of DHRs, clinical presentations and variabilities of immediate-type hypersensitivity reactions and delayed-type hypersensitivity reactions are mentioned in this article, including DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), SJS (Stevens- Johnson syndrome), TEN (Toxic Epidermal Necrolysis) and AGEP (Acute Generalized Exanthematous Pustulosis) and the most common culprit drugs. DHRs are an important public health issue due to their potential risk of life-threatening anaphylaxis and severe cutaneous adverse reactions.

Keywords:

clinical picture – classification – drug hypersensitivity – allergic reaction – non-allergic reaction – p-i concept

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