Intolerance to aspirin and the nonsteroidal anti-inflammatory drugs

Hypersensitivity reactions to small molecule drugs

Drug hypersensitivity reactions induced by small molecule drugs encompass a broad spectrum of adverse drug reactions with heterogeneous clinical presentations and mechanisms. These reactions are classified into allergic drug hypersensitivity reactions and non-allergic drug hypersensitivity reactions. At present, the hapten theory, pharmacological interaction with immune receptors (p-i) concept, altered peptide repertoire model, and altered T-cell receptor (TCR) repertoire model have been proposed to explain how small molecule drugs or their metabolites induce allergic drug hypersensitivity reactions. Meanwhile, direct activation of mast cells, provoking the complement system, stimulating or inhibiting inflammatory reaction-related enzymes, accumulating bradykinin, and/or triggering vascular hyperpermeability are considered as the main factors causing non-allergic drug hypersensitivity reactions. To date, many investigations have been performed to explore the underlying mechanisms involved in drug hypersensitivity reactions and to search for predictive and preventive methods in both clinical and non-clinical trials. However, validated methods for predicting and diagnosing hypersensitivity reactions to small molecule drugs and deeper insight into the relevant underlying mechanisms are still limited.

Mechanism of action of leukotrienes on the guinea pig bronchus

The pharmacological activity of leukotrienes (LT) A4, C4, D4, E4, and histamine was investigated on guinea pig upper and lower bronchi. The contractions of the upper bronchi to histamine, LTA4, C4 and D4 were enhanced by cyclooxygenase inhibitors aspirin (1.67 X 10(-5) and 1.67 X 10(-6) M) and indomethacin (2.8 X 10(-6) and 2.8 X 10(-5) M) whereas the responses to LTE4 were not affected. The myotropic activity of the lower bronchi to all agonists were either very slightly or not at all modified by the presence of cyclooxygenase inhibitors. The thromboxane synthetase inhibitor OKY-046 (1.77 X 10(-5) and 1.77 X 10(-6) M) did not change the responses of higher bronchi to the agonists which suggested that the response of the upper bronchi may be mediated by prostaglandins but not by thromboxanes. The responses of the lower bronchi to leukotrienes A4, C4, D4 and E4 were inhibited by compound OKY-046. Blockade of thromboxane receptors together with inhibition of lipoxygenases by compound L-655,240 (2.53 X 10(-8) to 2.53 X 10(-5) M) had a slight effect on the stimulation of upper and lower bronchi by leukotrienes and histamine. The compound FPL-55712 (1.92 X 10(-6) and 1.92 X 10(-5) M) strongly reduced the contractions of the upper and lower bronchi to leukotrienes but did not affect the responses to histamine. These results suggest that the contractile effects of leukotrienes on upper bronchi is modulated by bronchorelaxant prostaglandins whereas the responses of the lower bronchi are mediated by thromboxanes.(ABSTRACT TRUNCATED AT 250 WORDS)