A number of drugs and environmentally and occupa-tionally important chemicals can impair the activity of one or more components of the immune system. Immunodeficiency may result in increased susceptibility to infection, decreased surveillance against precancer-ous or cancerous cells, or tissue-damaging reactions (Table 7.1). Allergic and autoimmune reactions are examples of this form of toxicity.

Clinical expressions of cutaneous allergic reactions include eczematous, indurate-inflammatory, and ur-ticarial eruptions. Irritant responses causing direct damage to the skin may be confused with allergic responses involving immune mechanisms. An important difference is that allergic reactions require an initial exposure to sensitize the individual; dermatitis is then elicited by minimal subsequent exposure to the agent.

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