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Type II Autoimmune Drug Reactions

 
  • Examples:

  • Demonstrated antibodies to the drug or tissue constituents.

  • Idiopathic thrombocytopenic purpura: immune mechanisms

    • Granulocytes or blood platelets: damaged or activated by antigen-antibody complexes (may be destroyed by reticuloendothelial system)

  • Drug-induced autoimmune reactions: usually result within several months, following drug withdrawal

  •  Immunosuppressive treatment required only if autoimmune response is unacceptably severe.

 Serum sickness & Vasculitic (Type III) Reactions

  • More common then immediate anaphylactic reactions

  • Clinical Characteristics:

    • urticarial skin eruptions

    • arthritis

    • arthralgia

    • lymphadenopathy

    • fever

    • Duration: six-12 days

    • subsides after drug is discontinued

  • Typically due to complement-fixing antibodies:IgM or IgG class

  • Reduction of drug-induced serum sickness symptoms: corticosteroids

  • Immune Vasculitis: may be drug-induced--(hypersensitivity angiitis)

    • Examples:

      • sulfonamides

      • penicillin

      • thiouracil

      • anticonvulsants

      • iodides

    •  Mild skin disorder: erythema multiforme

      •  More severe reaction: Stevens-Johnson syndrome including:

        • erythema multiforme

        • arthritis

        • myocarditis

        • nephritis

        • CNS abnormalities

        • associated with  sulfonamide administration

Primary Source: Barbuto, J.A.M, Akporiaye, E.T. and Hersh, E.M. Immunopharmacology, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 916-940
Haynes, B. F., Fauci, A.S. Disorders of the Immune System, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 1753-1776.
Carpenter, C. B. The Major Histocompatibility Gene Complex, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 1777-1782.
Cooper,M.D, and Lawton III, A. R. Primary Immune Deficiency Diseases, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 1783-1791.
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