1. Time interval to reaction
|
a) In already sensitized patients |
-> immediate reaction |
immediate to 60 min |
-> delayed (non-immediate) |
> 1 h-several weeks |
b) In de novo sensitization while on treatment |
-> Typical sensitization latency |
5–10 Days |
2. Clinical manifestations
|
a) Immediate-type symptoms: e. g., flushing, urticaria, angioedema, bronchospasm, anaphylaxis |
b) Delayed-type symptoms: maculopapular drug eruptions, acute generalised exanthematic pustulosis (AGEP), severe cutaneous adverse reactions: Stevens-Johnson-Synrom (SJS), toxische epidermale Nekrolyse (TEN), „drug reaction with eosinophilia and systemic symptoms“ (DRESS) |
c) Specific symptoms: e. g., hepatitis, cytopenias, autoimmune diseases (e.g., lupus erythematosus, Ig-A dermatosis) |
3. Pathomechanisms
|
a) Immunological hypersensitivity reaction: immediate-type (type I according to Coombs and Gell, mostly IgE-mediated): typical manifestation, immediate-type symptoms |
Reaction time: 0–6 h (in rare cases, up to 12 h) |
b) Non-immunological hypersensitivity reaction: typical manifestation, immediate-type symptoms |
Reaction time: 0–6 h (in rare cases, up to 12 h) |
c) Immunological hypersensitivity reaction: delayed-type (type IV according to Coombs and Gell, T cell-mediated): typical manifestation, delayed-type symptoms |
Reaction time: 24–72 h (in rare cases, after 6 h) |
d) Other immunological hypersensitivity reactions (type II, type III according to Coombs and Gell, IgG-, IgA, or IgM-mediated): cytopenias, serum sickness, allergic vasculitis |
Reaction time: from 24 h |
In new sensitization under treatment |
Typical sensitization latency: 5–10 days in type I–IV, rarely longer: weeks to months, e. g., in SJS/TEN, DRESS, autoimmune diseases (e. g., lupus erythematosus) |