Table 1 Clinical spectrum of beta-lactam hypersensitivity
Gell and Coombs Classification (extended) | Type of immune response | Pathologic characteristics | Clinical symptoms |
|---|---|---|---|
Type I | IgE | Mast-cell degranulation | Urticaria, anaphylaxis |
Type II | IgG and FC receptor | FCR-dependent cell destruction | Blood cell dyscrasia |
Type III | IgG and complement or FC receptor | Immune complex deposition | Vasculitis |
Type IVa | Th1 (Interferon-γ) | Monocyte activation | Eczema |
Type IVb | Th2 (IL-5 and IL-4) | Eosinophilic inflammation | Maculopapular exanthema, bullous exanthema DRESS (drug reaction with eosinophilia and sytsemic symptoms) |
Type IVc | Cytotoxic lymphocytes (perforin and granzyme B) | CD4- or CD8-mediated killing of cells | Macuolopapular exanthema, eczema, bullous exanthema, pustular exanthema SJS/TEN (Stevens Johnson Syndrome/Toxic Epidermal Necrolysis) |
Type IVd | T cells (IL-8) | Neutrophil recruitment and activation | Pustular exanthema |