Mechanisms of Hypersensitivity

Baldo, Brian A.; Pham, Nghia H.

doi:10.1007/978-1-4614-7261-2_3

Cited by 12 publications

(40 citation statements)

References 33 publications

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“…The antibodies bind strongly (~K a 10 −10 M) via the Cε3 domain linker region to the high affinity FcεRI receptor abundantly expressed on mast cell and basophil surfaces forming a long-lasting IgE-FcεRI complex that dissociates slowly. Interaction of the combining sites of the cellbound bivalent antibodies with the complementary determinants of the provoking allergen in an allergic subject effects cross-linkage of adjacent antibodies, aggregation of the FcεRI receptors and the triggering of a rapid release of preformed mediators from the secretory granules of the cell [5][6][7] ( Figure 1). The released preformed mediators including histamine, platelet activating factor (PAF), heparin, neutrophil, eosinophil and monocyte chemotactic factors, serotonin and the enzymes tryptase, chymase and carboxypeptidase produce the early signs and symptoms seen in a type I hypersensitivity response, namely, vasodilation, edema, bronchospasm and pruritus.…”

Section: Type I Immediate Hypersensitivity: Ige Antibodies Mast Cellmentioning

confidence: 99%

“…Despite this perceived need for drugs to be presented in haptenated macromolecular form to induce an antibody response, specific IgE responses occur to a number of different unreactive drugs lacking both suitable functional groups and properties to account for the formation of drug-carrier antigens. In addition, IgE antibody responses, sometimes manifesting as lifethreatening anaphylaxis, are known to occur in some patients upon first exposure to the drug [4,5]. Here we examine IgE antibody responses in immediate, type I hypersensitivities to a range of different drugs together with findings so far on the specificities of the antibody combining site-drug allergenic determinants interactions.…”

Section: Introduction: Ige Antibody Recognition Of Drugsmentioning

confidence: 99%

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IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

Baldo

2014

Antibodies

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Abstract:The variety of chemically diverse pharmacologically-active compounds administered to patients is large and seemingly forever growing, and, with every new drug released and administered, there is always the potential of an allergic reaction. The most commonly occurring allergic responses to drugs are the type I, or immediate hypersensitivity reactions mediated by IgE antibodies. These reactions may affect a single organ, such as the nasopharynx (allergic rhinitis), eyes (conjunctivitis), mucosa of mouth/throat/tongue (angioedema), bronchopulmonary tissue (asthma), gastrointestinal tract (gastroenteritis) and skin (urticaria, eczema), or multiple organs (anaphylaxis), causing symptoms ranging from minor itching and inflammation to death. It seems that almost every drug is capable of causing an immediate reaction and it is unusual to find a drug that has not provoked an anaphylactic response in at least one patient. These facts alone indicate the extraordinary breadth of recognition of IgE antibodies for drugs ranging from relatively simple structures, for example, aspirin, to complex molecules, such as the macrolide antibiotics composed of a large macrocyclic ring with attached deoxy sugars. This wide recognition profile is borne out at the molecular level by results of quantitative immunochemical studies where hapten inhibition investigations have identified structural determinants complementary to IgE antibodies in the sera of allergic subjects. Allergenic determinants have been identified on a variety of drugs including neuromuscular blockers, penicillins, cephalosporins, opioids, thiopentone, sulfonamides, trimethoprim, quinolones, chlorhexidine and the non-steroidal anti-inflammatory drug aspirin. It is already clear that IgE can distinguish fine structural differences on a wide variety of molecules, determinants OPEN ACCESSAntibodies 2014, 3 57 may be at least as small as an amino group or encompass the whole molecule, and individual drugs may demonstrate allergenic heterogeneity.

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Section: Type I Immediate Hypersensitivity: Ige Antibodies Mast Cellmentioning

confidence: 99%

Section: Introduction: Ige Antibody Recognition Of Drugsmentioning

confidence: 99%

IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

Baldo

2014

Antibodies

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“…The main role of IgE antibodies in the allergic and inflammatory reaction during the immediate and late phases is completely understood. IgE is the mediator of this reaction [13] . Waxman et al [14] suggested the intake of systemic corticosteroids immediately after an operation to clear the sinuses from the fungal load that is entangeled within the inspissated allergic mucin.…”

Section: * Relation Between Increase In Ige In Percent and Study Groupsmentioning

confidence: 99%

The Relationship Between Systemic Steroid Therapy and the Level of Serum Ige in Allergic Fungal Rhinosinusitis

Zeid

Mohammed

El-Fouly

et al. 2016

Zagazig University Medical Journal

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Background: Adequate study of allergic fungal rhinosinusitis (AFRS) helped better understanding of the nature of the disease. It involves immediate hypersensitivity to fungus present in the nose and sinuses. This involves immunoglobulin E. Therefore the presence of serum IgE indicates the presence of the allergic reaction.The objective is to evaluate the relationship between systemic steroid therapy and the level of serum IgE in allergic fungal rhinosinusitis indicating adequate therapy. This is a prospective study. Subjects and Methods: Forty patients diagnosed as allergic fungal sinusitis were randomly divided into two equal groups: group A was given postoperative systemic steroids and local steroids, while group B was not given systemic steroids (local steroids only). The patients were followed up for three and six months by testing IgE levels in blood. Results: The total number of patients who had more than 10% increase in serum IgE after 6 months post-operative was 18 patients. Six of them were from group A (Systemic steroids) and 12 were from group B (Local steroids). Conclusion:There was a strong relation between systemic steroid therapy and the level of serum IgE. Thus, AFS should be treated by systemic steroids for a prolonged period after adequate clearance of the sinuses. Patients should be followed up at close intervals post-operative using serum Ig E as it can indicate increased fungal load and the need for further treatment.

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“…Symptoms usually resolve with the drug re-exposure likely due to the smaller tumor burden, and therefore lower cytokine release by the malignant cells [19]. Symptoms can be derived from several organs, such as nasopharynx (rhinitis), eyes (conjunctivitis), mucosa (angioedema), respiratory tissue (asthma), gastrointestinal tract (gastroenteritis) and skin (eczema) [20]. Systemic symptoms like fever, chills, flushing, rash, pruritus, dyspnea, back pain, headache, and distress have also been reported [15].…”

Section: Diagnosis and Grading Of Infusional Reactionsmentioning

confidence: 99%

“…Skin prick and intradermal tests, which involve the allergen injection into the skin dermis, have high predictive value in penicillin-induced reactions. However, in other cases, a negative test does not effectively rule out the presence of specific IgE antibodies [8], [20].…”

Section: Allergic Reactionsmentioning

confidence: 99%

Immediate Reactions To Monoclonal Antibodies In Clinical Hematology

Kyriazi

2016

IJMS

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Monoclonal antibodies (MoAbs) have been widely used in clinical hematology. As foreign macro-molecules, they can cause infusional reactions during the administration or within 24 hours after the infusion, which encompass a spectrum of mechanisms. Although most of these reactions are non-allergic, are often indistinguishable from true allergic reactions mediated by IgE immunoglobulins. The diagnosis is often challenging and relies mainly on clinical criteria. They occur during the first doses, soon after the initiation of treatment. The symptoms are usually well controlled by the immediate drug discontinuation or reduction of the infusion rate. The management remains largely supportive, consisting of oxygen, intravenous fluids, bronchodilators, antihistamines and steroids. Most of MoAb protocols recommend premedication with steroids and antihistamines and gradually escalating infusion rates. Increased medical and nursing vigilance is required and resuscitative equipment should always be readily available. These events affect patients' quality of life, leading to treatment delay or discontinuation and series of tests. The decision to rechallenge the treatment depends on severity grading, clinical parameters and treatment goals. This article provides an update of MoAbs used in clinical hematology. It summarizes the pathophysiology, the diagnostic approach, the preventive measures and treatment of MoAb-related reactions.

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Mechanisms of Hypersensitivity

Cited by 12 publications

References 33 publications

IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities

The Relationship Between Systemic Steroid Therapy and the Level of Serum Ige in Allergic Fungal Rhinosinusitis

Immediate Reactions To Monoclonal Antibodies In Clinical Hematology

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