{"id":7675,"date":"2020-06-18T20:37:20","date_gmt":"2020-06-18T20:37:20","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=7675"},"modified":"2026-01-07T20:48:03","modified_gmt":"2026-01-07T20:48:03","slug":"hypersensitivity-reactions","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/hypersensitivity-reactions\/","title":{"rendered":"The Gell-Coombs Classification of Hypersensitivity Reactions"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>The original Gell and Coomb&#8217;s classification categorizes hypersensitivity reactions into four subtypes according to the type of immune response and the effector mechanism responsible for cell and tissue injury: type I, immediate or IgE mediated; type II, cytotoxic or IgG\/IgM mediated; type III, IgG\/IgM immune complex mediated; and type IV, delayed-type hypersensitivity or T-cell mediated.<!--more--><\/p>\n<p>The classification has been improved so that type IIa is the former type II and type IIb is antibody-mediated cell stimulating (Graves Disease and the &#8220;autoimmune&#8221; type of chronic idiopathic urticaria). Type IV has four major categories: type IVa is CD4(+)Th1 lymphocyte mediated with activation of macrophages (granuloma formation and type I diabetes mellitus); type IVb is CD4(+)Th2 lymphocyte mediated with eosinophilic involvement (persistent asthma and allergic rhinitis); type IVc is cytotoxic CD8(+) T lymphocyte with involvement of perforin-granzyme B in apoptosis (Stevens-Johnson syndrome and toxic epidermal necrolysis); type IVd is T-lymphocyte-driven neutrophilic inflammation (pustular psoriasis and acute generalized exanthematous pustulosis). Some diseases have multiple types of immunologic hypersensitivity.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Classification of hypersensitivity reactions<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 16.5525%;\"><strong>Classification<\/strong><\/td>\n<td style=\"width: 38.984%;\"><strong>Immunoreactants<\/strong><\/td>\n<td style=\"width: 44.4634%;\"><strong>Clinical Presentation<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type I<\/td>\n<td style=\"width: 38.984%;\">Mast cell mediated, IgE dependent (anaphylactic, and IgE independent)<\/td>\n<td style=\"width: 44.4634%;\">Anaphylaxis, urticaria, angioedema, asthma, and allergic rhinitis<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type IIa<\/td>\n<td style=\"width: 38.984%;\">Antibody-mediated cytotoxic reactions (IgG and IgM antibodies complement often involved)<\/td>\n<td style=\"width: 44.4634%;\">Immune cytopenias<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type IIb<\/td>\n<td style=\"width: 38.984%;\">Antibody-mediated cell-stimulating reactions<\/td>\n<td style=\"width: 44.4634%;\">Graves disease and chronic idiopathic urticaria<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type III<\/td>\n<td style=\"width: 38.984%;\">Immune complex\u2013mediated reactions complement involved<\/td>\n<td style=\"width: 44.4634%;\">Serum sickness and vasculitis<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type IVa<\/td>\n<td style=\"width: 38.984%;\">Th1 cell-mediated reactions macrophage activation<\/td>\n<td style=\"width: 44.4634%;\">Type 1 diabetes and contact dermatitis (with IVc)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type IVb<\/td>\n<td style=\"width: 38.984%;\">Th2 cell\u2013mediated reactions eosinophilic inflammation<\/td>\n<td style=\"width: 44.4634%;\">Persistent asthma and allergic rhinitis<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type IVc<\/td>\n<td style=\"width: 38.984%;\">Cytotoxic T cell-mediated<br \/>\n(perforin\/granzyme B involved)<\/td>\n<td style=\"width: 44.4634%;\">Stevens-Johnson syndrome and toxic epidermal keratinocytes (TEN)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 16.5525%;\">Type IVd<\/td>\n<td style=\"width: 38.984%;\">T-cell-mediated neutrophilic inflammation<\/td>\n<td style=\"width: 44.4634%;\">Acute generalized exanthematous pustulosis (AGEP) and Behcet disease<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Dispenza MC. Classification of hypersensitivity reactions. Allergy Asthma Proc. 2019;40(6):470-473. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31690397\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Uzzaman A, Cho SH. Chapter 28: Classification of hypersensitivity reactions. Allergy Asthma Proc. 2012;33 Suppl 1:96-99. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22794701\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Rajan TV. The Gell-Coombs classification of hypersensitivity reactions: a re-interpretation. Trends Immunol. 2003;24(7):376-379. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12860528\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Jun 16, 2020.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[289],"tags":[166,167,2205,2204,1482,1481,2207,2206],"class_list":["post-7675","post","type-post","status-publish","format-standard","hentry","category-immunology","tag-clasificacion","tag-classification","tag-coombs","tag-gell","tag-hipersensibilidad","tag-hypersensitivity","tag-reacciones","tag-reactions"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/7675","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=7675"}],"version-history":[{"count":14,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/7675\/revisions"}],"predecessor-version":[{"id":9414,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/7675\/revisions\/9414"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=7675"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=7675"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=7675"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}