A “Rash” Decision in Anesthetic Management: Benzyl Alcohol Allergy in the Perioperative Period
Table 1
Gell and Coombs classification of hypersensitivity reactions distinguishes four types of immune responses [7, 13].
Type
Description
Mechanism
Clinical features
I
IgE-mediated, immediate-type hypersensitivity
Antigen exposure causes IgE-mediated activation of mast cells, causing the release of vasoactive substances (e.g., histamine) and inflammatory mediators)
Anaphylaxis Angioedema Bronchospasm Urticaria
II
Antibody-dependent cytotoxicity
Antigen/haptens on cells bind IgG and/or IgM antibodies, leading to cell or tissue injury via the complement (formation of the membrane attack complex) or phagocytosis
Hemolytic anemia Thrombocytopenia Neutropenia
III
Immune complex disease
Deposition of antigen-antibody complexes in vessels or tissue, leading to complement activation and recruitment of neutrophils by the interaction of immune complexes with Fc IgG receptors
Serum sickness Arthus reaction Glomerulonephritis
IV
Cell-mediated delayed-type hypersensitivity
Sensitized T lymphocytes encounter the antigen via MHC presentation, causing activation, which then mediates tissue injury
