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Type IV hypersensitivity disease

MedGen UID:
9371
•Concept ID:
C0020522
•
Pathologic Function
Synonyms: Delayed Hypersensitivities; Delayed Hypersensitivity; Hypersensitivity, Delayed; Hypersensitivity, Tuberculin Type; Hypersensitivity, Tuberculin-Type; Hypersensitivity, Type IV; Tuberculin Type Hypersensitivity; Tuberculin-Type Hypersensitivities; Tuberculin-Type Hypersensitivity; Type IV Hypersensitivities; Type IV Hypersensitivity
SNOMED CT: Cell-mediated immune reaction (28031001); Delayed hypersensitivity reaction (28031001); Gell and Coombs reaction type IV (28031001); Hypersensitivity reaction type IV (28031001)
 
Monarch Initiative: MONDO:0002459

Definition

Delayed hypersensitivity reaction (DTH) - type IV reaction, an inflammatory response that develops 24 to 72 hours after exposure to an antigen that the immune system recognizes as foreign. DTH is mediated by T cells rather than by antibodies. Th1 cells produce interferon gamma, interleukin (IL)-2, and tumor necrosis factor-beta and promote a cell-mediated immune response. [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVType IV hypersensitivity disease

Professional guidelines

PubMed

Neurosarcoidosis: Pathophysiology, Diagnosis, and Treatment.
Bradshaw MJ, Pawate S, Koth LL, Cho TA, Gelfand JM
Neurol Neuroimmunol Neuroinflamm 2021 Nov;8(6) Epub 2021 Oct 4 doi: 10.1212/NXI.0000000000001084. PMID: 34607912Free PMC Article
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management.
Frantz R, Huang S, Are A, Motaparthi K
Medicina (Kaunas) 2021 Aug 28;57(9) doi: 10.3390/medicina57090895. PMID: 34577817Free PMC Article
ERS clinical practice guidelines on treatment of sarcoidosis.
Baughman RP, Valeyre D, Korsten P, Mathioudakis AG, Wuyts WA, Wells A, Rottoli P, Nunes H, Lower EE, Judson MA, Israel-Biet D, Grutters JC, Drent M, Culver DA, Bonella F, Antoniou K, Martone F, Quadder B, Spitzer G, Nagavci B, Tonia T, Rigau D, Ouellette DR
Eur Respir J 2021 Dec;58(6) Epub 2021 Dec 16 doi: 10.1183/13993003.04079-2020. PMID: 34140301

Recent clinical studies

Etiology

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management.
Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA
J Am Acad Dermatol 2024 May;90(5):911-926. Epub 2023 Jul 28 doi: 10.1016/j.jaad.2023.02.073. PMID: 37516356
Drug Hypersensitivity Reactions.
Wilkerson RG
Immunol Allergy Clin North Am 2023 Aug;43(3):473-489. doi: 10.1016/j.iac.2022.10.005. PMID: 37394254
Drug-Induced Hypersensitivity Syndrome (DIHS)/Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Clinical Features and Pathogenesis.
Hama N, Abe R, Gibson A, Phillips EJ
J Allergy Clin Immunol Pract 2022 May;10(5):1155-1167.e5. Epub 2022 Feb 15 doi: 10.1016/j.jaip.2022.02.004. PMID: 35176506Free PMC Article
Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity.
Torres MJ, Trautmann A, Böhm I, Scherer K, Barbaud A, Bavbek S, Bonadonna P, Cernadas JR, Chiriac AM, Gaeta F, Gimenez-Arnau AM, Kang HR, Moreno E, Brockow K
Allergy 2021 May;76(5):1325-1339. doi: 10.1111/all.14656. PMID: 33170954
Irritant Contact Dermatitis.
Bains SN, Nash P, Fonacier L
Clin Rev Allergy Immunol 2019 Feb;56(1):99-109. doi: 10.1007/s12016-018-8713-0. PMID: 30293200

Diagnosis

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management.
Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA
J Am Acad Dermatol 2024 May;90(5):911-926. Epub 2023 Jul 28 doi: 10.1016/j.jaad.2023.02.073. PMID: 37516356
Drug Hypersensitivity Reactions.
Wilkerson RG
Immunol Allergy Clin North Am 2023 Aug;43(3):473-489. doi: 10.1016/j.iac.2022.10.005. PMID: 37394254
Drug-Induced Hypersensitivity Syndrome (DIHS)/Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Clinical Features and Pathogenesis.
Hama N, Abe R, Gibson A, Phillips EJ
J Allergy Clin Immunol Pract 2022 May;10(5):1155-1167.e5. Epub 2022 Feb 15 doi: 10.1016/j.jaip.2022.02.004. PMID: 35176506Free PMC Article
Irritant Contact Dermatitis.
Bains SN, Nash P, Fonacier L
Clin Rev Allergy Immunol 2019 Feb;56(1):99-109. doi: 10.1007/s12016-018-8713-0. PMID: 30293200
Tattoo complaints and complications: diagnosis and clinical spectrum.
Serup J, Carlsen KH, Sepehri M
Curr Probl Dermatol 2015;48:48-60. Epub 2015 Mar 26 doi: 10.1159/000369645. PMID: 25833625

Therapy

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis.
Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA
J Am Acad Dermatol 2024 May;90(5):885-908. Epub 2023 Jul 27 doi: 10.1016/j.jaad.2023.02.072. PMID: 37516359
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management.
Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA
J Am Acad Dermatol 2024 May;90(5):911-926. Epub 2023 Jul 28 doi: 10.1016/j.jaad.2023.02.073. PMID: 37516356
Treatment of Sarcoidosis: A Multidisciplinary Approach.
Gerke AK
Front Immunol 2020;11:545413. Epub 2020 Nov 19 doi: 10.3389/fimmu.2020.545413. PMID: 33329511Free PMC Article
Polymorphous Light Eruption.
Guarrera M
Adv Exp Med Biol 2017;996:61-70. doi: 10.1007/978-3-319-56017-5_6. PMID: 29124691
Tattoo complaints and complications: diagnosis and clinical spectrum.
Serup J, Carlsen KH, Sepehri M
Curr Probl Dermatol 2015;48:48-60. Epub 2015 Mar 26 doi: 10.1159/000369645. PMID: 25833625

Prognosis

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis.
Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA
J Am Acad Dermatol 2024 May;90(5):885-908. Epub 2023 Jul 27 doi: 10.1016/j.jaad.2023.02.072. PMID: 37516359
Nonlife-Threatening Sarcoidosis.
Castro MDC, Pereira CAC
Semin Respir Crit Care Med 2020 Oct;41(5):733-740. Epub 2020 Aug 10 doi: 10.1055/s-0040-1710371. PMID: 32777854
Advanced pulmonary sarcoidosis.
Patel DC, Valeyre D
Curr Opin Pulm Med 2020 Sep;26(5):574-581. doi: 10.1097/MCP.0000000000000705. PMID: 32740378
Advanced sarcoidosis.
Baughman RP, Wells A
Curr Opin Pulm Med 2019 Sep;25(5):497-504. doi: 10.1097/MCP.0000000000000612. PMID: 31365384
Irritant Contact Dermatitis.
Bains SN, Nash P, Fonacier L
Clin Rev Allergy Immunol 2019 Feb;56(1):99-109. doi: 10.1007/s12016-018-8713-0. PMID: 30293200

Clinical prediction guides

Severe delayed hypersensitivity reactions to IL-1 and IL-6 inhibitors link to common HLA-DRB1*15 alleles.
Saper VE, Ombrello MJ, Tremoulet AH, Montero-Martin G, Prahalad S, Canna S, Shimizu C, Deutsch G, Tan SY, Remmers EF, Monos D, Hahn T, Phadke OK, Cassidy E, Ferguson I, Mallajosyula V, Xu J, Rosa Duque JS, Chua GT, Ghosh D, Szymanski AM, Rubin D, Burns JC, Tian L, Fernandez-Vina MA, Mellins ED, Hollenbach JA; Drug Hypersensitivity Consortium; INCHARGE Consortium
Ann Rheum Dis 2022 Mar;81(3):406-415. Epub 2021 Nov 17 doi: 10.1136/annrheumdis-2021-220578. PMID: 34789453Free PMC Article
Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): An update in 2019.
Shiohara T, Mizukawa Y
Allergol Int 2019 Jul;68(3):301-308. Epub 2019 Apr 16 doi: 10.1016/j.alit.2019.03.006. PMID: 31000444
Dapsone: An Update.
Karjigi S, Murthy SC, Kallappa H, Kusuma MR, Aruna B, Reddy YN
Indian J Lepr 2016 Sep;87(4):233-239. PMID: 29762952
Biomarkers in sarcoidosis.
Chopra A, Kalkanis A, Judson MA
Expert Rev Clin Immunol 2016 Nov;12(11):1191-1208. Epub 2016 Jun 27 doi: 10.1080/1744666X.2016.1196135. PMID: 27253883
Tattoo complaints and complications: diagnosis and clinical spectrum.
Serup J, Carlsen KH, Sepehri M
Curr Probl Dermatol 2015;48:48-60. Epub 2015 Mar 26 doi: 10.1159/000369645. PMID: 25833625

Recent systematic reviews

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis.
Lee EY, Knox C, Phillips EJ
JAMA Dermatol 2023 Apr 1;159(4):384-392. doi: 10.1001/jamadermatol.2022.6378. PMID: 36790777Free PMC Article
Nipple eczema: A systematic review and practical recommendations.
Reynaert V, Gutermuth J, Wollenberg A
J Eur Acad Dermatol Venereol 2023 Jun;37(6):1149-1159. Epub 2023 Feb 16 doi: 10.1111/jdv.18920. PMID: 36695082
Systemic interventions for treatment of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome.
Jacobsen A, Olabi B, Langley A, Beecker J, Mutter E, Shelley A, Worley B, Ramsay T, Saavedra A, Parker R, Stewart F, Pardo Pardo J
Cochrane Database Syst Rev 2022 Mar 11;3(3):CD013130. doi: 10.1002/14651858.CD013130.pub2. PMID: 35274741Free PMC Article
Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis.
Fritz D, van de Beek D, Brouwer MC
BMC Neurol 2016 Nov 15;16(1):220. doi: 10.1186/s12883-016-0741-x. PMID: 27846819Free PMC Article
Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review.
Canavan TN, Mathes EF, Frieden I, Shinkai K
J Am Acad Dermatol 2015 Feb;72(2):239-45. doi: 10.1016/j.jaad.2014.06.026. PMID: 25592340

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