Whittingham S, Mackey I R
Med J Aust. 1976 Apr 3;1(14):486-8, 490-2.
Immunopathic disease resulting from drug treatment occurs when drugs interact with lymphoid cells and induce an immunological reaction. Drugs, being foreign to the body, are immunogenic, either as such or as haptens bound to carrier proteins. The immune response is usually innocuous or unnoticed but occasionally becomes pathogenic. The impact is especially obvious when the immunopathic response affects blood, skin, liver or kidney. Immunopathic responses and effector mechanisms of injury, whether to drugs or other antigens, are considered in terms of four types: Type I--anaphylactic and mediated by immunoglobulin (Ig) E antibody, and exemplified by immediate penicillin reactions; Type II--cytolytic and complement-associated, mediated by IgG antibody, and exemplified by haemolytic reactions; Type III--vasculonecrotic (Arthus reaction), mediated by immune complexes, and exemplified by serum sickness-like reaction; Type IV--delayed hypersensitivity involving T lymphocytes but no antibody, and exemplified by contact dermatitis. In addition, certain drugs induce true autoimmune reactions exemplified by reactions to procaine amide (lupus erythematosus) and alpha methyldopa (positive Coombs test result). Drug reactions must be interpreted in terms of modern immunology, with involvement of both the B and T lymphocyte systems. Inherited predisposition exists, probably dependent both on immune response genes and on the rate of enzymatic handling of drugs. Diagnosis depends on a carefully taken history of drug administration, recognition of clinical manifestations, and results of tests now available in departments of clinical immunology.
药物治疗引发的免疫性疾病发生于药物与淋巴细胞相互作用并诱发免疫反应之时。药物作为机体的外来物质，本身或作为与载体蛋白结合的半抗原具有免疫原性。免疫反应通常无害或未被察觉，但偶尔会致病。当免疫性反应影响血液、皮肤、肝脏或肾脏时，影响尤为明显。无论是针对药物还是其他抗原，免疫性反应及损伤的效应机制可分为四种类型：I型——由免疫球蛋白（Ig）E抗体介导的过敏反应，如青霉素即刻反应；II型——由IgG抗体介导的溶细胞性及补体相关反应，如溶血反应；III型——由免疫复合物介导的血管坏死性（阿瑟斯反应），如血清病样反应；IV型——涉及T淋巴细胞但无抗体的迟发型超敏反应，如接触性皮炎。此外，某些药物可诱发真正的自身免疫反应，如对普鲁卡因胺（红斑狼疮）和α-甲基多巴（抗人球蛋白试验阳性）的反应。必须依据现代免疫学来解释药物反应，其中涉及B淋巴细胞系统和T淋巴细胞系统。存在遗传易感性，可能既取决于免疫反应基因，也取决于药物的酶处理速率。诊断取决于仔细的用药史、临床表现的识别以及临床免疫科现有的检测结果。
