Type IV hypersensitivity occurs 24–48 hours after exposure to the allergen and therefore is called delayed type hypersensitivity (DTH). Like other drug hypersensitivities, the drug may chemically react with host tissue to create a new antigen. Upon first exposure to the allergen (drug), antigen-presenting cells stimulate a T-cell response specific for that allergen. This takes 1–2 weeks. Upon second and all subsequent exposures, tissue-derived antigen-presenting cells that come in contact with the new antigen (allergen-modified host protein) secrete chemokines and cytokines that attract memory T cells to the site of allergen re-exposure. This takes only 24–48 hours. Lymphocytes and antigen-presenting cells such as macrophages accumulate at the site, causing induration, erythema, and swelling. Contact hypersensitivity is a form of DTH and occurs when an allergen elicits DTH on the skin, resulting in spongiosis such as when an ointment containing an allergen is applied to skin.
GENERIC NAME AVAILABLE AS Abatacept Orencia Abciximab ReoPro Adalimumab Humira Ado-trastuzumab emtansine Kadcyla Alefacept Amevive Alemtuzumab Campath Alirocumab Praluent Anakinra Kineret GENERIC NAME AVAILABLE AS Etanercept Enbrel Afinitor, Zortress Evolocumab Repatha Gilenya Glatiramer acetate Copaxone Simponi Ibritumomab tiuxetan Zevalin Various
Azathioprine Generic, Imuran
Cyclosporine Generic, Sandimmune, Restasis
Interferon beta-1a Avonex, Rebif
Interferon beta-1b Betaseron, Extavia
Interleukin-2 (IL-2, aldesleukin) Proleukin
Mycophenolate mofetil Generic, CellCept
GENERIC NAME AVAILABLE AS Pegademase bovine (bovine adenosine deaminase) Adagen Pegaptanib Macugen Peginterferon alfa-2a Pegasys Peginterferon alfa-2b PEG-Intron Pembrolizumab Keytruda Pertuzumab Perjeta Pomalidomide Pomalyst Ramucirumab Cyramza Ranibizumab Lucentis Raxibacumab ABthrax Reslizumab Cinqair Rho(D) immune globulin micro-dose RhoGam, others GENERIC NAME AVAILABLE AS Rilonacept Arcalyst Rituximab Rituxan Scorpion antivenom (equine (Fab)¢2) Anascorp Siltuximab Sylvant Sirolimus Generic, Rapamune Tacrolimus (FK 506) Generic, Prograf, others Teriflunomide Aubagio Thalidomide Thalomid Tocilizumab Actemra Trastuzumab Herceptin UstekinumabStelaraVedolizumabEntyvio*Several drugs discussed in this chapter are available as orphan drugs but are not listed here. Other drugs not listed here will be found in other chapters (see Index).
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