Special Focus Review

Drug allergy: Causes and desensitization

Volume 8, Issue 10   October 2012
Pages 1513 - 1524
http://dx.doi.org/10.4161/hv.21889
Keywords: desensitization, drug allergy, drug allergy pathogenesis
Authors: Richard Warrington

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Abstract:
Allergic drug reactions occur when a drug, usually a low molecular weight molecule, has the ability to stimulate an immune response. This can be done in one of two ways. The first is by binding covalently to a self-protein, to produce a haptenated molecule that can be processed and presented to the adaptive immune system to induce an immune response. Sometimes the drug itself cannot do this but a reactive breakdown product of the drug is able to bind covalently to the requisite self-protein or peptide. The second way in which drugs can stimulate an immune response is by binding non-covalently to antigen presenting or antigen recognition molecules such as the major histocompatibility complex (MHC) or the T cell receptor. This is known as the p-I or pharmacological interaction hypothesis. The drug binding in this situation is reversible and stimulation of the response may occur on first exposure, not requiring previous sensitization. There is probably a dependence on the presence of certain MHC alleles and T cell receptor structures for this type of reaction to occur.

Received: July 18, 2012; Accepted: August 20, 2012; Published Online: August 24, 2012

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