Novel Pathway of IgE-Mediated Drug Allergy
Description
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Exposure and sensitization to certain drugs can ultimately lead to Ig-E mediated allergic reactions. ① Dendritic cells take up covalently bound happen-carrier adducts (true antigens), process them into peptides, then present them on HLA to T cells. ② T cells in response secrete cytokines to promote B-cell maturation into plasma cells that produce hapten-carrier-specific IgE. ③ Released IgEs bind to receptors on mast cells, where they cross-link to hapten-carrier complexes. Increasing amounts of hapten-carrier/IgE antibodies interaction with receptors make mast cells unresponsive. ④ Upon re-exposure, drugs can form large amounts of non-covalent drug-carrier complexes (fake antigens) that can bind to the preformed drug-specific IgE on mast cells, prompting mast cell degranulation, with clinical symptoms
Acknowledgements
References
Pichler, WJ. (2019) Immune pathomechanism and classification of drug hypersensitivity. Allergy.https://onlinelibrary.wiley.com/doi/full/10.1111/all.13765
Pichler WJ. Anaphylaxis to drugs: Overcoming mast cell unresponsiveness by fake antigens. Allergy. 2020 Aug 11. doi: 10.1111/all.14554.
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