In this chapter, emphasis has been placed on the core mechanisms underlying the broad categories of hypersensitivity responses distinguished on the basis of the Gell and Coombs classification and based on differences in the immune reactants (antibodies or cells), the form of the presented antigen, and the effector mechanisms involved. Mechanisms involved in individual drug hypersensitivities including responses to reactive metabolites from chemically "inert" parent drugs such as sulfamethoxazole; relationships between chemical structures and immune responses seen with, for example, anaphylactic reactions to neuromuscular blocking drugs (NMBDs) during anesthesia; hypersensitivities and other intolerances to non-steroidal anti-inflammatory drugs; and mechanisms underlying the killing of malignant cells by some drugs used in chemotherapy are not confined to this chapter but presented in the relevant chapters dealing with pharmacologically different groups of drugs. Most hypersensitivities to drugs manifest as type I or type IV reactions. Type II and type III drug hypersensitive reactions are far less often seen and are considered after the discussions of the types I and IV responses. Mechanisms, to the extent that they are currently understood, of other types of "hypersensitivity" reactions or intolerances, some mediated by antibodies other than IgE and others by cells, are also discussed. We begin by examining the mechanisms underlying type I drug-induced IgE antibody allergic sensitization, regulation, and production and the effector mechanisms operative in IgE-mediated allergic reactions.
3.1Allergic Sensitization to Drugs and the Dogma of Previous Exposure
Immunogenicity of Free and Conjugated Drugs