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Kanannejad Z, Pourvali A, Esmaeilzadeh H, Shokouhi Shoormasti R, Reza Fazlollahi M, Fallahpour M, Zaremehrjardi F. Diagnosis and selection of alternative antibiotics in beta-lactams hypersensitivity reactions: Current recommendations and challenges. Int Immunopharmacol 2023; 122:110573. [PMID: 37413935 DOI: 10.1016/j.intimp.2023.110573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
Beta-lactam (BLM) antibiotics, including amino-penicillin and cephalosporins, are typically the first-choice treatment for bacterial infections. However, adverse reactions to these antibiotics are frequently reported, causing non-allergist physicians to select alternative broad-spectrum antibiotics that can have harmful consequences. Patients with unclear histories of hypersensitivity reactions to BLMs should undergo an allergy workup to establish a firm diagnosis, particularly when different drugs are prescribed simultaneously. However, finding the safest, most precise, and cost-effective methods for confirming BLMs hypersensitivity and selecting the most appropriate alternative BLM is uncertain, particularly in severe delayed reactions. This review aims to provide data and recommendations on the availability and validity of skin tests (STs), drug provocation test (DPT) protocols, based on the latest published literature and guideline. To make the process more practical, we focused on cross-reactivity between BLMs and diagnostic tests. There are two main novel aspects of this document: 1) For T-cell-mediated reactions, patient stratification into high, moderate, and low-risk groups based on the mortality and morbidity of adverse drug reactions. 2) For IgE-mediated reactions, stratification of individuals with isolated limited urticarial without anaphylaxis in a low-risk group and removal of the extensive limitation.
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Affiliation(s)
- Zahra Kanannejad
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Pourvali
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Hossein Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz, Iran.
| | - Raheleh Shokouhi Shoormasti
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical, Sciences, Tehran, Iran
| | - Mohammad Reza Fazlollahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical, Sciences, Tehran, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasoole- Akaram Medical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Fatemeh Zaremehrjardi
- Allergist and Clinical Immunologist, Clinical Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Iran
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Athavale A, Thao M, Sassaki VS, Lewis M, Chandra V, Fukaya E. Cyanoacrylate glue reactions: A systematic review, cases, and proposed mechanisms. J Vasc Surg Venous Lymphat Disord 2023; 11:876-888.e1. [PMID: 37054883 DOI: 10.1016/j.jvsv.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Cyanoacrylate glue closure was first used in humans 10 years ago to treat venous reflux of the axial veins. Studies have since shown its clinical efficacy in vein closure. However, great need exists to elucidate further the types of specific adverse reactions that cyanoacrylate glue can cause for better patient selection and to minimize these events. In the present study, we systematically reviewed the literature to identify the types of reported reactions. In addition, we explored the pathophysiology contributing to these reactions and proposed the mechanistic pathway with inclusion of actual cases. METHODS We searched the literature for reports of reactions following cyanoacrylate glue use in patients with venous diseases between 2012 and 2022. The search was performed using MeSH (medical subject headings) terms. The terms included cyanoacrylate, venous insufficiency, chronic venous disorder, varicose veins, vein varicosities, venous ulcer, venous wound, CEAP (clinical, etiologic, anatomic, pathophysiologic), vein, adverse events, phlebitis, hypersensitivity, foreign body granuloma, giant cell, endovenous glue-induced thrombosis, and allergy. The search was limited to the literature reported in English. These studies were evaluated for the type of product used and the reactions noted. A systematic review, in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) method, was performed. Covidence software (Melbourne, VC, Australia) was used for full-text screening and data extraction. Two reviewers reviewed the data, and the content expert served as the tiebreaker. RESULTS We identified 102, of which, 37 reported on cyanoacrylate use other than in the context of chronic venous diseases and were excluded. Fifty-five reports were determined appropriate for data extraction. The adverse reactions to cyanoacrylate glue were phlebitis, hypersensitivity, foreign body granuloma, and endovenous glue-induced thrombosis. CONCLUSIONS Although cyanoacrylate glue closure for venous reflux is generally a safe and clinically effective treatment choice for patients with symptomatic chronic venous disease and axial reflux, some adverse events could be specific to the properties of the cyanoacrylate product. We propose mechanisms for how such reactions can occur based on histologic changes, published reports, and case examples; however, further exploration is necessary to confirm these theories.
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Affiliation(s)
- Anand Athavale
- Division of Vascular Surgery, Stanford School of Medicine, Palo Alto, CA
| | | | | | - Matthew Lewis
- Department of Dermatology, Stanford School of Medicine, Palo Alto, CA
| | - Venita Chandra
- Division of Vascular Surgery, Stanford School of Medicine, Palo Alto, CA
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford School of Medicine, Palo Alto, CA.
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3
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Almeida JI. The story of N-butyl cyanoacrylate saphenous vein ablation. J Vasc Surg Venous Lymphat Disord 2023; 11:889-890. [PMID: 37328234 DOI: 10.1016/j.jvsv.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Jose I Almeida
- Miami Vein, Voluntary Professor of Surgery Division of Vascular and Endovascular Surgery University of Miami Miller School of Medicine, Miami, FL
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4
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Evaluation of Delayed-Type Hypersensitivity to Antineoplastic Drugs-An Overview. Cancers (Basel) 2023; 15:cancers15041208. [PMID: 36831549 PMCID: PMC9954236 DOI: 10.3390/cancers15041208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Nowadays, clinical practice encounters the problem of delayed-type hypersensitivity (DTH) induced by several drugs. Antineoplastic treatments are among the drugs which show an elevated proportion of DHT reactions, leading to the worsening of patients' quality of life. The range of symptoms in DHT reactions can vary from mild, such as self-limiting maculopapular eruptions, to severe, such as Stevens-Johnson Syndrome. The development of these reactions supposes a negative impact, not only by limiting patients' quality of life, but also leading to economic loss due to market withdrawal of the affected drugs and high hospitalization costs. However, despite this problem, there are no available standard in vitro or in vivo methods that allow for the evaluation of the sensitizing potential of drugs in the preclinical phase. Therefore, the aim of this review is to summarize the skin reactions caused by the different antineoplastic families, followed by a comprehensive evaluation of the in vitro and in vivo methods used to detect DTHs and that could be suitable to test antineoplastic hypersensitivity reactions.
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5
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Elzagallaai AA, Rieder MJ. Pathophysiology of drug hypersensitivity. Br J Clin Pharmacol 2022. [PMID: 36519187 DOI: 10.1111/bcp.15645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Drug hypersensitivity reactions (DHRs) are type B adverse drug reactions (ADRs) traditionally defined as unpredictable, dose independent and not related to the drug pharmacology. DHRs, also called drug allergy if the immune system involvement is confirmed, represent around one-sixth of all ADRs and can cause major clinical problems due to their vague clinical presentation and irregular time course. Understanding the underlying pathophysiology of DHRs is very important for their diagnosis and management. Multiple layers of evidence exist pointing to the involvement of the immune system in DHRs. Recent data have led to a paradigm shift in our understanding of the exact pathophysiology of these reactions. Numerous hypotheses proposing explanation on how a low molecular weight drug molecule can elicit an immune reaction have been proposed. In addition to the classical "hapten" hypothesis, the reactive metabolite hypothesis, the pharmacological interaction with the immune system (p-i) concept, the danger/injury hypothesis and the altered peptide repertoire hypothesis have been proposed. We here introduce the inflammasome activation hypothesis and the cross-reactivity hypothesis as additional models explaining the pathophysiology of DHRs. Available data supporting these hypotheses are briefly summarized and discussed. We also introduced the cross-reactivity model, which may provide a platform to appreciate the potential role played by other factors leading to the activation of the immune system. We believe that although the drug in question could be the trigger of the reaction, the components of the immune system mediating the reaction do not act in isolation but rather are affected by the proinflammatory milieu occurring at the time of the reaction. This review attempts to summarize the available evidence to further illustrate the pathophysiology of DHRs.
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Affiliation(s)
- Abdelbaset A Elzagallaai
- Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Michael J Rieder
- Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Pediatrics and Physiology, University of Western Ontario, London, Ontario, Canada
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Bergmann C, Poli A, Agache I, Bianchini R, Bax HJ, Castells M, Crescioli S, Dombrowicz D, Ferastraoaru D, Fiebiger E, Gould HJ, Hartmann K, Izquierdo E, Jordakieva G, Josephs DH, Jutel M, Levi‐Schaffer F, de las Vecillas L, Lotze MT, Osborn G, Pascal M, Redegeld F, Rosenstreich D, Roth‐Walter F, Schmidt‐Weber C, Shamji M, Steveling EH, Turner MC, Untersmayr E, Jensen‐Jarolim E, Karagiannis SN. AllergoOncology: Danger signals in allergology and oncology: A European Academy of Allergy and Clinical Immunology (EAACI) Position Paper. Allergy 2022; 77:2594-2617. [PMID: 35152450 PMCID: PMC9545837 DOI: 10.1111/all.15255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023]
Abstract
The immune system interacts with many nominal 'danger' signals, endogenous danger-associated (DAMP), exogenous pathogen (PAMP) and allergen (AAMP)-associated molecular patterns. The immune context under which these are received can promote or prevent immune activating or inflammatory mechanisms and may orchestrate diverse immune responses in allergy and cancer. Each can act either by favouring a respective pathology or by supporting the immune response to confer protective effects, depending on acuity or chronicity. In this Position Paper under the collective term danger signals or DAMPs, PAMPs and AAMPs, we consider their diverse roles in allergy and cancer and the connection between these in AllergoOncology. We focus on their interactions with different immune cells of the innate and adaptive immune system and how these promote immune responses with juxtaposing clinical outcomes in allergy and cancer. While danger signals present potential targets to overcome inflammatory responses in allergy, these may be reconsidered in relation to a history of allergy, chronic inflammation and autoimmunity linked to the risk of developing cancer, and with regard to clinical responses to anti-cancer immune and targeted therapies. Cross-disciplinary insights in AllergoOncology derived from dissecting clinical phenotypes of common danger signal pathways may improve allergy and cancer clinical outcomes.
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Affiliation(s)
- Christoph Bergmann
- Department of OtorhinolaryngologyRKM740 Interdisciplinary ClinicsDüsseldorfGermany
| | - Aurélie Poli
- Neuro‐Immunology GroupDepartment of OncologyLuxembourg Institute of HealthLuxembourgLuxembourg
| | - Ioana Agache
- Faculty of MedicineTransylania University BrasovBrasovRomania
| | - Rodolfo Bianchini
- Comparative MedicineThe Interuniversity Messerli Research InstituteUniversity of Veterinary Medicine ViennaMedical University of ViennaUniversity of ViennaViennaAustria
| | - Heather J. Bax
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom,School of Cancer and Pharmaceutical SciencesGuy's Hospital, King's College LondonLondonUnited Kingdom
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Silvia Crescioli
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom
| | - David Dombrowicz
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐EGIDLilleFrance
| | - Denisa Ferastraoaru
- Department of Internal Medicine/Allergy and Immunology, Montefiore Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Edda Fiebiger
- Division of Gastroenterology, Hepatology and Nutrition Research, Department of Medicine ResearchChildren's University Hospital BostonBostonMassachusettsUSA
| | - Hannah J. Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic & Medical BiosciencesKing's College London, New Hunt's HouseLondonUnited Kingdom,Medical Research Council & Asthma UK Centre in Allergic Mechanisms of AsthmaLondonUnited Kingdom
| | - Karin Hartmann
- Department of DermatologyUniversity of BaselBaselSwitzerland
| | - Elena Izquierdo
- IMMA, School of Medicine, Institute of Applied Molecular MedicineCEU San Pablo UniversityMadridSpain
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational MedicineMedical University of ViennaViennaAustria
| | - Debra H. Josephs
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom,School of Cancer and Pharmaceutical SciencesGuy's Hospital, King's College LondonLondonUnited Kingdom
| | - Marek Jutel
- Department of Clinical ImmunologyWroclaw Medical UniversityWroclawPoland,ALL‐MED Medical Research InstituteWroclawPoland
| | - Francesca Levi‐Schaffer
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Faculty of MedicineThe Institute for Drug Research, The Hebrew University of JerusalemJerusalemIsrael
| | | | - Michael T. Lotze
- G.27A Hillman Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Gabriel Osborn
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom
| | - Mariona Pascal
- Department of Immunology, CDB, Hospital Clinic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de BarcelonaBarcelonaSpain
| | - Frank Redegeld
- Division of Pharmacology, Faculty of ScienceUtrecht Institute for Pharmaceutical Sciences, Utrecht UniversityUtrechtThe Netherlands
| | - David Rosenstreich
- Department of Internal Medicine/Allergy and Immunology, Montefiore Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Franziska Roth‐Walter
- Comparative MedicineThe Interuniversity Messerli Research InstituteUniversity of Veterinary Medicine ViennaMedical University of ViennaUniversity of ViennaViennaAustria,Center of Pathophysiology, Infectiology and ImmunologyInstitute of Pathophysiology and Allergy Research, Medical University ViennaViennaAustria
| | - Carsten Schmidt‐Weber
- Center of Allergy & Environment (ZAUM)Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental HealthMunichGermany,German Center for Lung Research (DZL)MunichGermany
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical ImmunologyImperial College LondonLondonUnited Kingdom
| | | | | | - Eva Untersmayr
- Center of Pathophysiology, Infectiology and ImmunologyInstitute of Pathophysiology and Allergy Research, Medical University ViennaViennaAustria
| | - Erika Jensen‐Jarolim
- Comparative MedicineThe Interuniversity Messerli Research InstituteUniversity of Veterinary Medicine ViennaMedical University of ViennaUniversity of ViennaViennaAustria,Center of Pathophysiology, Infectiology and ImmunologyInstitute of Pathophysiology and Allergy Research, Medical University ViennaViennaAustria
| | - Sophia N. Karagiannis
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesGuy's Hospital, King's College LondonLondonUnited Kindgom,Breast Cancer Now Research UnitSchool of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital,LondonSE1 9RTUnited Kindgom
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7
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Miyagawa H, Hara H, Araya J, Minagawa S, Numata T, Umezawa Y, Asahina A, Nakagawa H, Kuwano K. Characteristics of anti-IL-17/23 biologics-induced interstitial pneumonia in patients with psoriasis. PLoS One 2021; 16:e0245284. [PMID: 33411857 PMCID: PMC7790374 DOI: 10.1371/journal.pone.0245284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/24/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives Anti-IL-17/23 biologics are increasingly used to treat psoriasis. We aimed to elucidate characteristics of drug-induced interstitial pneumonia (DIIP) caused by anti-IL-17/23 biologics. Methods We retrospectively analyzed the clinical data of psoriasis patients treated with anti-IL-17/23 biologics. Chest CT was performed to evaluate DIIP. Serum KL-6 levels were measured before treatment (baseline) and during treatment. Results A total of 603 psoriasis patients were treated with anti-IL-17/23 biologics with mean follow-up of 21.1 months. Six patients developed DIIP at mean 14 months after initiation of the therapy. Older age, higher baseline KL-6 value and more frequent pre-existing IPs were associated with development of DIIP by univariate analysis. At the onset of DIIP, elevated serum KL-6 levels with concomitantly increased ground glass opacity (GGO) in Chest CT were demonstrated. DIIP was improved by only cessation of causative agents in five patients but steroid therapy was needed in one patient. Conclusions DIIP is a plausible complication of anti-IL-17/23 biologics. Age, baseline KL-6 level and underlying IP could be the risk factors for DIIP development. Serum KL-6 levels and chest CT are useful for not only predicting but also detecting DIIP caused by anti-IL-17/23 biologics.
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Affiliation(s)
- Hanae Miyagawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- * E-mail: (HH); (HM)
| | - Hiromichi Hara
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- * E-mail: (HH); (HM)
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Minagawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinori Umezawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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8
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Hammond S, Thomson PJ, Ogese MO, Naisbitt DJ. T-Cell Activation by Low Molecular Weight Drugs and Factors That Influence Susceptibility to Drug Hypersensitivity. Chem Res Toxicol 2019; 33:77-94. [PMID: 31687800 DOI: 10.1021/acs.chemrestox.9b00327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Drug hypersensitivity reactions adversely affect treatment outcome, increase the length of patients' hospitalization, and limit the prescription options available to physicians. In addition, late stage drug attrition and the withdrawal of licensed drugs cost the pharmaceutical industry billions of dollars. This significantly increases the overall cost of drug development and by extension the price of licensed drugs. Drug hypersensitivity reactions are characterized by a delayed onset, and reactions tend to be more serious upon re-exposure. The role of drug-specific T-cells in the pathogenesis of drug hypersensitivity reactions and definition of the nature of the binding interaction of drugs with HLA and T-cell receptors continues to be the focus of intensive research, primarily because susceptibility is associated with expression of one or a small number of HLA alleles. This review critically examines the mechanisms of T-cell activation by drugs. Specific examples of drugs that activate T-cells via the hapten, the pharmacological interaction with immune receptors and the altered self-peptide repertoire pathways, are discussed. Furthermore, the impacts of drug metabolism, drug-protein adduct formation, and immune regulation on the development of drug antigen-responsive T-cells are highlighted. The knowledge gained from understanding the pathways of T-cell activation and susceptibility factors for drug hypersensitivity will provide the building blocks for the development of predictive in vitro assays that will prevent or help to minimize the incidence of these reactions in clinic.
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Affiliation(s)
- Sean Hammond
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| | - Paul J Thomson
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| | - Monday O Ogese
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| | - Dean J Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
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9
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Galbiati V. In vitro testing of drug-induced systemic hypersensitivity: Just a burden or an opportunity? CURRENT OPINION IN TOXICOLOGY 2017. [DOI: 10.1016/j.cotox.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Gomes ER, Kuyucu S. Epidemiology and Risk Factors in Drug Hypersensitivity Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0128-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Raghavan R, Shawar S. Mechanisms of Drug-Induced Interstitial Nephritis. Adv Chronic Kidney Dis 2017; 24:64-71. [PMID: 28284381 DOI: 10.1053/j.ackd.2016.11.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/11/2022]
Abstract
Drug-induced acute interstitial nephritis (DI-AIN) is a drug hypersensitivity reaction (DHR) that manifests 7 to 10 days after exposure to the culprit drug. DHRs account for fewer than 15% of reported adverse drug reactions. The kidneys are susceptible to DHR because: (1) the high renal blood flow whereby antigens are filtered, secreted, or concentrated, and (2) it is a major site of excretion for drugs and drug metabolites. More than 250 different drugs from various classes have been incriminated as causative agents of DI-AIN, the third most common cause of acute kidney injury in the hospital. DI-AIN must be differentiated from drug-induced nephrotoxic acute tubular necrosis because of their differing pathophysiology and treatment. DI-AIN begins with antigen processing and presentation to local dendritic cells. The dendritic cells activate T cells, and the subsequent effector phase of the immune response is mediated by various cytokines. Incriminated antigenic mechanisms include response to a conjugation product of the drug or its metabolite with a host protein (eg, beta-lactam or sulfonamide antibiotic) or the direct binding of the drug to a particular host allele to elicit a hypersensitivity response (eg, certain anti-epileptic drugs). If the offending drug is not identified and discontinued in a timely manner, irreversible fibrosis and chronic kidney disease will occur. The core structure of each drug or its metabolite is an antigenic determinant, and the host interaction is termed the structure-activity relationship. Differing structure-activity relationships accounts for effect, hypersensitivity, and cross-reactivity among and between classes. The essence of management of DI-AIN lies with the four sequential steps: anticipation, diagnosis, treatment, and prevention. Corticosteroids are used in the treatment of DI-AIN because of their potent anti-inflammatory effects on T cells and eosinophils. Anticipation and prevention require notifying the patient that DI-AIN is an idiosyncratic, hypersensitivity reaction that recurs on re-exposure, and the drug should be avoided.
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12
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Cho T, Uetrecht J. How Reactive Metabolites Induce an Immune Response That Sometimes Leads to an Idiosyncratic Drug Reaction. Chem Res Toxicol 2016; 30:295-314. [DOI: 10.1021/acs.chemrestox.6b00357] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tiffany Cho
- Faculty
of Pharmacy, University of Toronto, Toronto, Ontario, Canada M5S 3M2
| | - Jack Uetrecht
- Faculty
of Pharmacy, University of Toronto, Toronto, Ontario, Canada M5S 3M2
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13
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Galbiati V, Papale A, Kummer E, Corsini E. In vitro Models to Evaluate Drug-Induced Hypersensitivity: Potential Test Based on Activation of Dendritic Cells. Front Pharmacol 2016; 7:204. [PMID: 27462271 PMCID: PMC4940371 DOI: 10.3389/fphar.2016.00204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/27/2016] [Indexed: 01/11/2023] Open
Abstract
Hypersensitivity drug reactions (HDRs) are the adverse effect of pharmaceuticals that clinically resemble allergy. HDRs account for approximately 1/6 of drug-induced adverse effects, and include immune-mediated ("allergic") and non-immune-mediated ("pseudo allergic") reactions. In recent years, the severe and unpredicted drug adverse events clearly indicate that the immune system can be a critical target of drugs. Enhanced prediction in preclinical safety evaluation is, therefore, crucial. Nowadays, there are no validated in vitro or in vivo methods to screen the sensitizing potential of drugs in the pre-clinical phase. The problem of non-predictability of immunologically-based hypersensitivity reactions is related to the lack of appropriate experimental models rather than to the lack of -understanding of the adverse phenomenon. We recently established experimental conditions and markers to correctly identify drug associated with in vivo hypersensitivity reactions using THP-1 cells and IL-8 production, CD86 and CD54 expression. The proposed in vitro method benefits from a rationalistic approach with the idea that allergenic drugs share with chemical allergens common mechanisms of cell activation. This assay can be easily incorporated into drug development for hazard identification of drugs, which may have the potential to cause in vivo hypersensitivity reactions. The purpose of this review is to assess the state of the art of in vitro models to assess the allergenic potential of drugs based on the activation of dendritic cells.
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Affiliation(s)
- Valentina Galbiati
- Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano Milan, Italy
| | - Angela Papale
- Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano Milan, Italy
| | - Elena Kummer
- Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano Milan, Italy
| | - Emanuela Corsini
- Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano Milan, Italy
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14
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Schiavino D, Nucera E, De Pasquale T, Roncallo C, Pollastrini E, Lombardo C, Giuliani L, Larocca LM, Buonomo A, Patriarca G. Delayed Allergy to Aminopenicillins: Clinical and Immunological Findings. Int J Immunopathol Pharmacol 2016; 19:831-40. [PMID: 17166404 DOI: 10.1177/039463200601900412] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aminopenicillins are the most used β-lactam antibiotics. Morbilliform or maculopapular rashes are rather frequent during therapy with aminopenicillins. The pathogenesis of these reactions is often due to a cell-mediated allergy. The aim of this work is to characterize patients with cell-mediated allergy to aminopenicillins and to identify alternative β-lactam drugs that can be safely administered to these patients. We studied 27 subjects affected by cell-mediated allergy to aminopenicillins. The diagnosis was made on the basis of positivity of patch tests with aminopenicillins. These patients then underwent an allergological evaluation (skin and patch tests, oral and/or intramuscular challenge tests) with a wide spectrum of β-lactam antibiotics. Our work highlights the following main characteristics of cell-mediated allergy to aminopenicillins: time elapsing between drug administration and onset of symptoms of about 2 days; the maculopapular rash and delayed appearance of urticaria/angioedema were the most typical symptoms (82.8% of cases); a cross-reactivity with aminocephalosporins is usually absent, or it is limited to cephalexin (in our study, in fact, just 3 out of 20 patients challenged with cephalexin showed a positive oral challenge test); all the β-lactams, other than aminopenicillins, are well tolerated. Patch tests represent a specific diagnostic tool with a good predictive value of identifying alternative drugs that can be safely administered to patients with β-lactam allergy. Our patients could tolerate other β-lactam drugs after a complete allergological evaluation. On the basis of our study, cell-mediated allergy to aminopenicillins should be considered a well-defined nosologic entity.
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Affiliation(s)
- D Schiavino
- Department of Allergy, Catholic University, Policlinico Gemelli, Rome, Italy
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15
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Schrijvers R, Gilissen L, Chiriac AM, Demoly P. Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from bedside to bench and back. Clin Transl Allergy 2015; 5:31. [PMID: 26339470 PMCID: PMC4558726 DOI: 10.1186/s13601-015-0073-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/29/2015] [Indexed: 01/11/2023] Open
Abstract
Drug hypersensitivity reactions (DHR) have been present since the advent of drugs. In particular T-cell mediated delayed-type hypersensitivity reactions represent a heterogeneous clinical entity with a diverse pathogenesis and result in a considerable burden of morbidity and mortality not only driven by the reactions themselves but also by the use of alternatives which are sometimes less effective or even more dangerous. Diagnostic procedures rely on clinical history, skin testing and potential provocation testing, whereas validated in vitro diagnostic procedures are still lacking for most of them. Recent work in the field of pharmacogenomics combined with basic scientific research has provided insights in the pathogenesis of abacavir and carbamazepine hypersensitivities linked with certain human leucocyte antigen risk alleles. Nevertheless, important scientific questions on how other DHR arise and how host-drug interactions occur, remain unanswered. Recent work indicates an intricate relation between host, drug and pathogens in severe cutaneous and systemic reactions and provides more insights in the role of regulatory T-cells and viral reactivation in these reactions. In this review we focus on type IV delayed-type DHR, and address recent advances in the pathogenesis, pharmacogenomics, and diagnosis of these reactions with an emphasis on the understandings arising from basic research.
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Affiliation(s)
- Rik Schrijvers
- Laboratory of Clinical Immunology, KU Leuven, Leuven, Belgium ; Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Gilissen
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Anca Mirela Chiriac
- Exploration des Allergies, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Paris, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - Pascal Demoly
- Exploration des Allergies, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Paris, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
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Abstract
Acute interstitial nephritis (AIN) is an under recognized and under diagnosed cause of acute kidney injury (AKI). It is estimated to account for 15 - 20% of cases of AKI; it is the reported diagnosis in 2.8% of all kidney biopsies, and 13.5% of biopsies done specifically for acute renal failure. Considerable evidence implicates antigen initiated cell-mediated injury in the pathogenesis of AIN. Drugs account for 70% of all cases, with over 150 different agents incriminated. The remaining cases are due to infections, autoimmune diseases, and rarely idiopathic. The central component of renal injury in AIN is altered tubular function, which usually precedes decrements in filtration rate. The key to early diagnosis is vigilance for the presence of tubular dysfunction in non-oliguric individuals, especially in patients with modest but gradual increments in creatinine level. The utility of urinary biomarkers to diagnose AIN in its early nascent and potentially reversible stage remains to be determined. Prompt recognition, elimination of the offending source of antigen, and use of a limited course of steroid therapy where indicated, will result in complete resolution in ~ 65% of cases, partial resolution in up to 20%, and irreversible damage in the rest.
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Watanabe S, Nitta N, Sonoda A, Nitta-Seko A, Ohta S, Tsuchiya K, Otani H, Tomozawa Y, Nagatani Y, Mukaisho K, Takahashi M, Murata K. Inhibition of fibrosis and inflammation by triple therapy with pirfenidone, edaravone and erythropoietin in rabbits with drug-induced lung injury: comparison of CT imaging and pathological findings. Exp Ther Med 2013; 6:1096-1100. [PMID: 24223628 PMCID: PMC3820844 DOI: 10.3892/etm.2013.1308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/03/2013] [Indexed: 12/29/2022] Open
Abstract
In a rabbit model of bleomycin-induced lung injury, computed tomography (CT) and pathological studies were conducted to investigate whether the progression of this injury is inhibited by pirfenidone and by triple therapy with pirfenidone, edaravone and erythropoietin. We divided nine rabbits with bleomycin-induced lung injury into three equally sized groups. Group 1 served as the control, group 2 received pirfenidone alone and group 3 was treated with pirfenidone, edaravone and erythropoietin. Multidetector CT (MDCT) scans were acquired immediately after the administration of bleomycin, and further scans were performed on days 14 and 28. The area of abnormal opacity was calculated. The rabbit lungs were removed and the size of abnormal areas in macroscopic specimens was calculated and the degree of fibrosis and inflammation in microscopic specimens was scored. In order, the average size of the area of abnormal opacity on CT scans was largest in group 1, followed by groups 2 and 3. On day 28, the area of opacity was significantly smaller in group 3 than in group 1 (P=0.071). The average size of the area of abnormal opacity on macroscopic findings was largest in group 1, followed in order by groups 2 and 3; the difference between group 1 and 3 was significant (P<0.05). The average fibrosis score was highest in group 3 followed by groups 2 and 1. By contrast, the average inflammation score was highest in group 2 followed by groups 1 and 3. Although the administration of pirfenidone alone slowed the progression of bleomycin-induced lung injury, the triple-drug combination was more effective.
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Affiliation(s)
- Shobu Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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Neuman MG, McKinney KK, Nanau RM, Kong V, Malkiewicz I, Mazulli T, Moussa G, Cohen LB. Drug-induced severe adverse reaction enhanced by human herpes virus-6 reactivation. Transl Res 2013; 161:430-40. [PMID: 23333110 DOI: 10.1016/j.trsl.2012.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/17/2012] [Accepted: 12/20/2012] [Indexed: 01/20/2023]
Abstract
Reactivation of certain latent viruses has been linked with a more severe course of drug-induced hypersensitivity reaction (HSR). For example, reactivation of human herpes virus (HHV)-6 is associated with severe organ involvement and a prolonged course of disease. The present study discusses an HSR developed in a previously healthy male exposed to ceftriaxone, doxycycline, vancomycin, and trimethoprim/sulfamethoxazole (co-trimoxazole; TMP/SMX). Initially, the patient presented clinical manifestations of HSR, as well as clinical and laboratory measurements compatible with liver and renal failure. Moreover, the patient presented skin desquamation compatible with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis. During the reaction, it was observed HHV-6 reactivation. The severity of clinical symptoms is correlated with HHV-6 titer, as well as with results of the in vitro lymphocyte toxicity assay (LTA). Serum levels of a large panel of cytokines are compared between the patient, a large population of SJS patients, and a cohort of healthy controls, using data collected by our laboratory over the years. HHV-6 was measured in the cell culture media from lymphocytes incubated with each of the 4 drugs. Moreover, we describe a new assay using cytokines released by patient lymphocytes following in vitro exposure to the incriminated drugs as biomarkers of HSR. Based on LTA results, HHV-6 reactivation and cytokine measurements, we establish that only doxycycline and TMP/SMX were involved in the HSR. As result of this analysis, the patient could continue to use the other 2 antibiotics safely.
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Affiliation(s)
- Manuela G Neuman
- In Vitro Drug Safety and Biotechnology, Toronto, Ontario, Canada.
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Chan ALF, Yu Lee H, Leung HWC. Fatal anaphylactic reaction to intravenous cephalexin. Clin Drug Investig 2012; 25:675-8. [PMID: 17532713 DOI: 10.2165/00044011-200525100-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Agnes L F Chan
- Department of Pharmacy, Chi Mei Medical Center, Tainan, TaiwanChia Nan University of Pharmacy and Science, Tainan, Taiwan
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20
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Matsuno O. Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches. Respir Res 2012; 13:39. [PMID: 22651223 PMCID: PMC3426467 DOI: 10.1186/1465-9921-13-39] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 05/16/2012] [Indexed: 02/06/2023] Open
Abstract
Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated. DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions. One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic.
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Affiliation(s)
- Osamu Matsuno
- Division of Medicine for Allergic Disease, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan.
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21
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Lin M, Sun W, Wang Y, Li X, Jin Y, Gong W, Fan X, Wang Y. An intravenous exposure mouse model for prediction of potential drug-sensitization using reporter antigens popliteal lymph node assay. J Appl Toxicol 2011; 32:395-401. [PMID: 21721018 DOI: 10.1002/jat.1696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 04/28/2011] [Accepted: 04/28/2011] [Indexed: 11/09/2022]
Abstract
Immune-mediated drug hypersensitivity is a particularly concerning health-safety issue among clinicians given its unpredictability and potentially life-threatening effects, especially with exposure to intravenous drugs. Therefore, the development of intravenous drug-exposure models for drug-hazard assessments has garnered increasing interest in recent years. In this study, we used reporter antigens popliteal lymph node assay to investigate the potential value of intravenous exposure to a selected variety of allergenic compounds, including ovalbumin (OVA), concanavalin A (ConA) and diclofenac. The trinitrophenyl (TNP)-specific antibody-forming cells were used to assess the systemic immune responses to a bystander antigen. Mice were subsequently sensitized by TNP-OVA, and then intravenous exposure to one of the selective compounds. As expected, all positive compounds induced significant popliteal lymph node (PLN) proliferation compared with the control. OVA significantly increased Cluster of Differentiation 4 receptors (CD⁴)⁺ interleukin-4 (IL-4)⁺ T-helper 2 (Th2) cells and, consequently, increased the ratios of IL-4/interferon-γ (IFN-γ) antibody-forming cells (AFCs) in PLNs, while bringing about a dose-dependent increase in immunoglobulin G1 (IgG1) AFCs; these findings indicate that a Th2 hypersensitivity response was induced. A Th2 response was also observed in diclofenac sodium-treated groups, and for ConA, a more mixed Th1/Th2 immune response appeared to be induced. In addition, there was no marked reaction with the negative compound. Together, it seems likely that the intravenous exposure model may be useful for drug-induced systemic hypersensitivity assessments.
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Affiliation(s)
- Mingbao Lin
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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22
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Haptenation: chemical reactivity and protein binding. J Allergy (Cairo) 2011; 2011:839682. [PMID: 21785613 PMCID: PMC3138048 DOI: 10.1155/2011/839682] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/27/2011] [Indexed: 11/23/2022] Open
Abstract
Low molecular weight chemical (LMW) allergens are commonly referred to as haptens. Haptens must complex with proteins to be recognized by the immune system. The majority of occupationally related haptens are reactive, electrophilic chemicals, or are metabolized to reactive metabolites that form covalent bonds with nucleophilic centers on proteins. Nonelectrophilic protein binding may occur through disulfide exchange, coordinate covalent binding onto metal ions on metalloproteins or of metal allergens, themselves, to the major histocompatibility complex. Recent chemical reactivity kinetic studies suggest that the rate of protein binding is a major determinant of allergenic potency; however, electrophilic strength does not seem to predict the ability of a hapten to skew the response between Th1 and Th2. Modern proteomic mass spectrometry methods that allow detailed delineation of potential differences in protein binding sites may be valuable in predicting if a chemical will stimulate an immediate or delayed hypersensitivity. Chemical aspects related to both reactivity and protein-specific binding are discussed.
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Magnan A, Pipet A, Bérard F, Malinovsky JM, Mertes PM. Mécanismes immunologiques de l’allergie peranesthésique. ACTA ACUST UNITED AC 2011; 30:240-5. [DOI: 10.1016/j.annfar.2010.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kim SH, Lee JE, Kim SH, Jee YK, Kim YK, Park HS, Min KU, Park HW. Allelic variants of CD40 and CD40L genes interact to promote antibiotic-induced cutaneous allergic reactions. Clin Exp Allergy 2009; 39:1852-6. [DOI: 10.1111/j.1365-2222.2009.03336.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Lavergne SN, Trepanier LA. Anti-platelet antibodies in a natural animal model of sulphonamide-associated thrombocytopaenia. Platelets 2009; 18:595-604. [DOI: 10.1080/09537100701392913] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Masubuchi Y, Horie T. Toxicological Significance of Mechanism-Based Inactivation of Cytochrome P450 Enzymes by Drugs. Crit Rev Toxicol 2008; 37:389-412. [PMID: 17612953 DOI: 10.1080/10408440701215233] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cytochrome P450 (P450) enzymes oxidize xenobiotics into chemically reactive metabolites or intermediates as well as into stable metabolites. If the reactivity of the product is very high, it binds to a catalytic site or sites of the enzyme itself and inactivates it. This phenomenon is referred to as mechanism-based inactivation. Many clinically important drugs are mechanism-based inactivators that include macrolide antibiotics, calcium channel blockers, and selective serotonin uptake inhibitors, but are not always structurally and pharmacologically related. The inactivation of P450s during drug therapy results in serious drug interactions, since irreversibility of the binding allows enzyme inhibition to be prolonged after elimination of the causal drug. The inhibition of the metabolism of drugs with narrow therapeutic indexes, such as terfenadine and astemizole, leads to toxicities. On the other hand, the fate of P450s after the inactivation and the toxicological consequences remains to be elucidated, while it has been suggested that P450s modified and degraded are involved in some forms of tissue toxicity. Porphyrinogenic drugs, such as griseofulvin, cause mechanism-based heme inactivation, leading to formation of ferrochelatase-inhibitory N-alkylated protoporphyrins and resulting in porphyria. Involvement of P450-derived free heme in halothane-induced hepatotoxicity and catalytic iron in cisplatin-induced nephrotoxicity has also been suggested. Autoantibodies against P450s have been found in hepatitis following administration of tienilic acid and dihydralazine. Tienilic acid is activated by and covalently bound to CYP2C9, and the neoantigens thus formed activate immune systems, resulting in the formation of an autoantibodydirected against CYP2C9, named anti-liver/kidney microsomal autoantibody type 2, whereas the pathological role of the autoantibodies in drug-induced hepatitis remains largely unknown.
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Affiliation(s)
- Yasuhiro Masubuchi
- Laboratory of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Chiba Institute of Science, Chosi, Japan
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Lavergne SN, Drescher NJ, Trepanier LA. Anti-myeloperoxidase and anti-cathepsin G antibodies in sulphonamide hypersensitivity. Clin Exp Allergy 2007; 38:199-207. [PMID: 17976219 DOI: 10.1111/j.1365-2222.2007.02845.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anti-neutrophil cytoplasmic antibodies (ANCA) are associated with vasculitis in humans. Sulphonamide antimicrobials cause drug hypersensitivity (HS) reactions with some clinical signs that are suggestive of vasculitis. OBJECTIVE The purpose of this study was to determine whether sulphonamide HS is associated with anti-neutrophil antibodies, using the dog as a spontaneous clinical model. METHODS Thirty-four sulphonamide-HS dogs, 11 sulphonamide-'tolerant' dogs, and nine healthy sulphonamide-naïve dogs were evaluated for anti-neutrophil antibodies using a commercial ELISA against human myeloperoxidase (MPO), a commercial human ANCA Western blot protocol, and immunoblotting against whole canine neutrophils. RESULTS Using ELISA, anti-MPO antibodies were found with an apparent higher frequency in HS dogs (50%), compared with 'tolerant' dogs (18%), which also showed significantly lower absorbances. Among HS dogs, anti-MPO antibodies were significantly more common, with significantly higher absorbances, in dogs that did not survive the HS reaction (78%) compared with survivors (35%). Using immunoblotting, ANCA were detected with similar overall frequencies in HS and 'tolerant' dogs. However, one protein targeted by several HS dogs, but no 'tolerant' dogs, was identified as cathepsin G. CONCLUSION These data indicate that anti-MPO antibodies and anti-cathepsin G antibodies are associated with sulphonamide HS. Anti-MPO antibodies have been shown to be pathogenic both in vitro and in vivo, leading to vasculitis lesions and vasculitis-like syndromes. The present study therefore suggests that vasculitis might be one mechanism of tissue damage in this sulphonamide HS. Furthermore, the evaluation of ANCA, and its relationship to disease severity and clinical outcome, should be considered in human patients with sulphonamide drug HS.
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Affiliation(s)
- S N Lavergne
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Yoshizawa Y, Kuramochi J, Jinta T, Kishi M, Mitaka K, Tamaoka M, Furuie M, Miyazaski Y, Otani Y, Inase N. [Etiological mechanism for drug-induced pulmonary dysfunction]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2007; 96:1091-6. [PMID: 17607982 DOI: 10.2169/naika.96.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Neuman M, Nicar M. Apoptosis in ibuprofen-induced Stevens-Johnson syndrome. Transl Res 2007; 149:254-9. [PMID: 17466924 DOI: 10.1016/j.trsl.2006.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 11/19/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
Cytokines play a role in the immunopathological and molecular mechanisms of drug-induced hypersensitivity reactions (HSR). The objective of the current report was to analyze the reliability and correlation between the clinical symptoms observed in a patient that presented an ibuprofen-induced Stevens-Johnson Syndrome (SJS), her lymphocyte toxicity assay to the incriminated drug, and the cytokine secretion in the patient's sera. In her skin biopsy, the apoptotic keratinocytes is shown. Clinically, the patient presented a triad that characterizes "true" HSR (rash, fever, and liver involvement). The pro-inflammatory cytokines were significantly higher in sera from the patient than in sera from control patients (analyzed previously in the authors' laboratory). More specifically, the high level of tumor necrosis factor alpha (TNF-alpha) is as high as in patients found to have toxic epidermal necrolysis (TEN) and presenting "true" HSR, eg, rash, fever, and organ involvement. The same is the case with the apoptotic markers Fas, caspase activity, and M30. T-cell cytokines control the pathogenesis of SJS/TEN contributing to apoptotic processes in the liver and in the skin.
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Affiliation(s)
- Manuela Neuman
- In Vitro Drug Safety and Biotechnology Laboratory, University of Toronto, Toronto, Ontario, Canada.
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31
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Neuman MG, Shear NH, Malkiewicz IM, Taeri M, Shapiro LE, Krivoy N, Haber J, Gomez M, Fish J, Cartotto R, Cohen L. Immunopathogenesis of hypersensitivity syndrome reactions to sulfonamides. Transl Res 2007; 149:243-53. [PMID: 17466923 DOI: 10.1016/j.trsl.2006.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 12/22/2006] [Accepted: 12/22/2006] [Indexed: 11/30/2022]
Abstract
Cytokines play a role in the immunopathological and molecular mechanisms of sulfonamide-induced hypersensitivity reactions (HSRs). The objective of this study was to analyze the reliability and correlation between the clinical symptoms observed in affected patients (n = 86) because of a sulfonamide-induced HSR and their lymphocyte toxicity assay (LTA) values. Another goal was to determine the cytokine secretion in the patient's sera and their expression in the peripheral blood mononuclear cells (PBMCs) and to explore whether a correlation exists among positive LTA score, cytokine levels, and HSR occurrence. The final goal is to determine whether these measures could be used to predict the likelihood of a patient to experience an HSR during sulfonamide treatment. Such a predictive ability would be valuable to the clinician to know whether the patient would tolerate sulfonamides or whether an alternative antibiotic should be prescribed. The LTA showed a good correlation with the clinical involvement of patients with hypersensitivity syndromes. In addition, the pro-inflammatory cytokines presented significant differences in patients that had rash, fever, and organ involvement than in control patients or any of the other patient groups. Expression of tumor necrosis factor alpha (TNF-alpha) is significantly higher in patients presenting rash, fever, and organ involvement versus all other groups. It is concluded that a positive LTA is a predictor for sulfonamide-induced true HSR. In addition, T-helper cell 1 cytokines [TNF-alpha, interleukins (ILs) 1 and 2] as well as the chemokine regulated upon activation, normal T-cell expressed and secreted (RANTES) control the pathogenesis of sulfonamide-induced HSR and may be used in early diagnosis of the syndrome.
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Affiliation(s)
- Manuela G Neuman
- In Vitro Drug Safety and Biotechnology Laboratory, University of Toronto, Toronto, Ontario, Canada.
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Pieters R. Detection of autoimmunity by pharmaceuticals. Methods 2007; 41:112-7. [PMID: 17161307 DOI: 10.1016/j.ymeth.2006.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 09/22/2006] [Indexed: 02/02/2023] Open
Abstract
Despite the important health and economic impact of autoimmunogenicity or allergenicity by pharmaceuticals models to detect such adverse effects are not available yet. The most important reason for this is the related complex interplay of multiple factors, for which reason these adverse effects are also referred to as idiosyncratic in nature. Moreover, clinical effects are quite diverse, and involve both organ-specific and systemic effects, including a diversity of skin diseases. Because of its complexity on the one hand and the fundamental knowledge on certain particular mechanistic effects it may be more relevant to design a rationalistic toolbox of test models from which a predictive strategy can be composed. Since one mechanistic aspect centers around T cell sensitization a straightforward lymph node assay such as the reporter antigen-popliteal lymph node assay (RA-PLNA) would fit in such a toolbox. This RA-PLNA holds a strong promise to distinguish sensitizing and/or neoantigen-forming capacity of low molecular weight pharmaceuticals. In addition, from the pharmacokinetic point of view a rationalistic toolbox should also contain oral exposure models with immunological read out parameters in normal or in genetically predisposed animal strains. This review focuses on these two categories of candidate test methods, PLNA and oral exposure models, and proposes to use these in tandem in order to predict the hazard of induction of allergy or autoimmune phenomena by new pharmaceutical candidates.
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Affiliation(s)
- Raymond Pieters
- Institute for Risk Assessment Sciences, Immunotoxicology, Utrecht University, The Netherlands.
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Bhaiya P, Roychowdhury S, Vyas PM, Doll MA, Hein DW, Svensson CK. Bioactivation, protein haptenation, and toxicity of sulfamethoxazole and dapsone in normal human dermal fibroblasts. Toxicol Appl Pharmacol 2006; 215:158-67. [PMID: 16603214 PMCID: PMC1615915 DOI: 10.1016/j.taap.2006.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 02/02/2006] [Accepted: 02/02/2006] [Indexed: 01/19/2023]
Abstract
Cutaneous drug reactions (CDRs) associated with sulfonamides are believed to be mediated through the formation of reactive metabolites that result in cellular toxicity and protein haptenation. We evaluated the bioactivation and toxicity of sulfamethoxazole (SMX) and dapsone (DDS) in normal human dermal fibroblasts (NHDF). Incubation of cells with DDS or its metabolite (D-NOH) resulted in protein haptenation readily detected by confocal microscopy and ELISA. While the metabolite of SMX (S-NOH) haptenated intracellular proteins, adducts were not evident in incubations with SMX. Cells expressed abundant N-acetyltransferase-1 (NAT1) mRNA and activity, but little NAT2 mRNA or activity. Neither NAT1 nor NAT2 protein was detected. Incubation of NHDF with S-NOH or D-NOH increased reactive oxygen species formation and reduced glutathione content. NHDF were less susceptible to the cytotoxic effect of S-NOH and D-NOH than are keratinocytes. Our studies provide the novel observation that NHDF are able to acetylate both arylamine compounds and bioactivate the sulfone DDS, giving rise to haptenated proteins. The reactive metabolites of SMX and DDS also provoke oxidative stress in these cells in a time- and concentration-dependent fashion. Further work is needed to determine the role of the observed toxicity in mediating CDRs observed with these agents.
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Affiliation(s)
- Payal Bhaiya
- Division of Pharmaceutics, College of Pharmacy, The University of Iowa, Iowa City, IA
| | - Sanjoy Roychowdhury
- Division of Pharmaceutics, College of Pharmacy, The University of Iowa, Iowa City, IA
| | - Piyush M. Vyas
- Division of Pharmaceutics, College of Pharmacy, The University of Iowa, Iowa City, IA
| | - Mark A. Doll
- Department of Pharmacology & Toxicology, University of Louisville School of Medicine, Louisville, KY
| | - David W. Hein
- Department of Pharmacology & Toxicology, University of Louisville School of Medicine, Louisville, KY
| | - Craig K. Svensson
- Division of Pharmaceutics, College of Pharmacy, The University of Iowa, Iowa City, IA
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Neuman MG, Monteiro M, Rehm J. Drug interactions between psychoactive substances and antiretroviral therapy in individuals infected with human immunodeficiency and hepatitis viruses. Subst Use Misuse 2006; 41:1395-463. [PMID: 17002989 DOI: 10.1080/10826080600846235] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The liver disease characteristic of alcohol dependence encompasses three main related entities: steatosis, alcoholic hepatitis, and cirrhosis. Alcoholic cirrhosis is a leading cause of global morbidity and mortality. Alcohol intake among injecting drug users is a major contributor to transmission of viral infections, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C viruses (HCV). HIV and HCV coinfected patients develop liver diseases earlier and more severely than the monoinfected individuals, including hepatocellular carcinoma. Interactions exist between the therapeutic drugs used to minimize and control the drug and alcohol dependence. Furthermore, drug-drug interactions occur between the highly active antiretroviral therapy (HAART) and alcohol, different HAART components and methadone, or each one of the therapies with the other, thus contributing to a higher toxicity level. With the evolution of effective antiretroviral therapy, survival of persons with HIV, and the syndrome it causes, acquired immunodeficiency syndrome (AIDS) has increased dramatically. Drug-drug interactions may appear between alcohol and anti-HBV or anti-HCV, therapy in the presence or absence of anti-HIV therapy. Several other medical-, social-, and drug-related factors of this population have to be considered when providing HAART. Because many coinfected patients also have problems with substance use, dealing with their drug dependence is an important first step in an attempt to improve adherence to and tolerance of antiviral therapy. It is necessary to minimize the risk of liver disease acceleration and/or reinfection with hepatitis viruses. Knowledge of potential drug interactions between methadone, antiretroviral therapy, psychoactive drugs, and antipsychotics and the role of coinfection with HBV or HCV and the drugs used in eradicating viral hepatitis permits suitable antiretroviral combinations.
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Aihara Y, Ito S, Aihara M, Kobayashi Y, Yokota S. Different patterns of cytokines, ECP and immunoglobulin profiles at two adverse drug reactions in a patient. Pediatr Int 2005; 47:616-21. [PMID: 16354212 DOI: 10.1111/j.1442-200x.2005.02143.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Drug-induced hypersensitivity syndrome (HS) is a rare but life-threatening disease. We experienced carbamazepine-induced HS in a 14-year-old boy, who had cefaclor-induced cutaneous eruptions 15 months later. To clarify the mechanisms of HS and the differences between two diseases we studied this case in detail. METHODS We investigated the associated viral agents by polymerase chain reaction and the specific antibodies. We also studied the mechanism of diseases by measuring chemical mediators including cytokines, ECP and immunoglobulins. RESULTS The patient was diagnosed as having carbamazepine-induced HS associated with reactivation of human herpesvirus 6 based on the clinical course and laboratory data including drug-induced lymphocyte stimulation tests. Similarly, the diagnosis of cefaclor-induced eruption without any viral reactivation was made. Serum levels of IFN-gamma, IL-6, TNF-alpha, IL-5 and ECP were increased significantly at HS but mildly at cefaclor-induced eruptions. Furthermore, we detected transient hypogammaglobulinemia only at HS. CONCLUSIONS This is the first report of anticonvulsant-induced HS followed by antibiotic-induced eruptions in a patient. In addition, we demonstrated difference in serum levels of inflammatory cytokines, immunoglobulins, activated eosinophils and viral reactivation between these diseases. This case would contribute to the understanding of the pathophysiology of adverse drug reactions including HS.
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Affiliation(s)
- Yukoh Aihara
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan.
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Kaplan J, Anand P, Frieri M. Rash, drug hypersensitivity, and autoimmunity in a 20-year-old woman. Ann Allergy Asthma Immunol 2005; 95:111-4. [PMID: 16136759 DOI: 10.1016/s1081-1206(10)61199-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer Kaplan
- Division of Allergy Immunology, Nassau University Medical Center, East Meadow, New York 11554, USA
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Nierkens S, Aalbers M, Bol M, Bleumink R, van Kooten P, Boon L, Pieters R. Differential Requirement for CD28/CTLA-4-CD80/CD86 Interactions in Drug-Induced Type 1 and Type 2 Immune Responses to Trinitrophenyl-Ovalbumin. THE JOURNAL OF IMMUNOLOGY 2005; 175:3707-14. [PMID: 16148116 DOI: 10.4049/jimmunol.175.6.3707] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of mAbs to abrogate costimulatory interactions has attracted much attention with regard to prevention and modulation of adverse (auto)immune-like reactions. However, the role of costimulatory molecules and possible therapeutic use of Ab-treatment in drug-induced immunostimulation is poorly elucidated. In the present studies, we show that CD28/CTLA-4-CD80/CD86 costimulatory interactions differently regulate drug-induced type 1 and type 2 responses to an identical bystander Ag, TNP-OVA, in BALB/c mice using the reporter Ag popliteal lymph node assay. The antirheumatic drug D-Penicillamine, which may induce lupus-like side-effects, stimulated type 2 responses against TNP-OVA, characterized by the production of IL-4 and TNP-specific IgG1 and IgE. These responses were abrogated in CD80/CD86-deficient mice and in wild-type mice that were treated with anti-CD80 and anti-CD86, or CTLA-4-Ig. Anti-CTLA-4 intensively enhanced the D-Penicillamine-induced effects. In contrast, the type 1 response (IFN-gamma, TNF-alpha, IgG2a) to TNP-OVA induced by the diabetogen streptozotocin still developed in the absence of CD80/CD86 costimulatory signaling. In addition, it was demonstrated that coadministration of anti-CD80 and anti-CD86 mAbs slightly enhanced streptozotocin-induced type 1 responses, whereas the CTLA-4-Ig fusion protein completely abrogated this response. In conclusion, different drugs may stimulate distinct types of immune responses against an identical bystander Ag, which are completely dependent on (type 2) or independent of (type 1) the CD28/CTLA-4-CD80/CD86 pathway. Importantly, the effects of treatment with anti-CD80/CD86 mAbs and CTLA-4-Ig may be considerably different in responses induced by distinct drugs.
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Affiliation(s)
- Stefan Nierkens
- Institute for Risk Assessment Sciences, Immunotoxicology, Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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Kim SH, Choi JH, Park HS. Heterogeneity of the IgE response to allergenic determinants of cefaclor in serum samples from patients with cefaclor-induced anaphylaxis. Ann Allergy Asthma Immunol 2005; 94:700-4. [PMID: 15984605 DOI: 10.1016/s1081-1206(10)61331-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Beta-lactam antibiotics, such as cefaclor, may cause IgE-mediated anaphylactic reactions. However, the clinically available serologic test has not been widely accepted, and the antigenic determinants of these drugs are unclear. OBJECTIVE To describe 4 cases of anaphylaxis caused by cefaclor in which a specific IgE response to cefaclor was demonstrated. METHODS Four patients with anaphylaxis to cefaclor and 35 nonatopic controls never exposed to cefaclor were studied. Skin tests and oral challenges with this drug were performed. The specific IgE response to the antigenic determinant of cefaclor-human serum albumin (HSA) conjugate was compared in each patient. The serum specific IgE to cefaclor-HSA conjugate was detected using enzyme-linked immunosorbent assay (ELISA). Also, ELISA inhibition studies using various concentrations of cefaclor-HSA, HSA alone, and free cefaclor were performed, as were hapten inhibition studies using cefaclor, cephalexin, cefadroxil, ampicillin, ceftriaxone, and cefotaxime. RESULTS Three patients showed high levels of serum specific IgE to cefaclor-HSA and marked inhibition patterns to free cefaclor and cefaclor-HSA conjugate on ELISA inhibition testing. Hapten inhibition testing in 3 individual serum samples showed 2 different patterns. In patient 3, significant dose-dependent inhibitions (up to 92%) were noted with additions of free cefaclor and cefaclor-HSA conjugate, and lesser inhibitions (up to 74%) were noted with cephalexin, which shares the aminobenzyl side chain. In patients 1 and 2, marked dose-dependent inhibitions were noted only with additions of cefaclor-HSA conjugate and free cefaclor, whereas minimal inhibitions were noted with the other 5 compounds. CONCLUSIONS The specific IgE response to cefaclor-HSA conjugate in patients with cefaclor anaphylaxis occurs against the hapten, in which heterogeneity of the antigenic determinant was noted to depend on the individual.
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Affiliation(s)
- Sang-Hoon Kim
- Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
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Abstract
PURPOSE OF REVIEW Drug hypersensitivity reactions are relatively rare but may result in severe morbidity and fatalities. Due to the idiosyncratic nature and multifactorial etiology of these reactions, development of a single animal model to study the immunosensitizing mechanisms of all drugs is impossible. This hampers the development of predictive screening models that are urgently needed to assess the immunostimulating capacity of newly developed drugs. The present review will focus on recent findings on mechanisms of drug hypersensitivity reactions obtained with murine models, and on the use of these models as potential screening tools to assess the immunostimulating capacity of drugs. RECENT FINDINGS Mechanisms of drug-induced sensitization versus tolerance appear dependent on generally accepted immunological paradigms. For instance, co-stimulatory signaling by antigen-presenting cells is decisive in drug-induced immunosensitization and both T cells and antigen-presenting cells are important for the induction of tolerance to orally administered drugs. From recent studies it has been hypothesized that expression of stress-associated transcription factors and the expression of costimulatory molecules or cytokine production within hours or days after the initial exposure may be representative of drug-induced hypersensitivity reactions and may thus be used as predictive parameters to screen for immunosensitizing drugs. SUMMARY The development of animal models to study mechanisms of drug hypersensitivity reactions is still in its infancy. Much effort has been made, however, to search for early indicators of immunostimulation in murine animal models that may eventually appear useful in a tiered strategy to assess drug-induced sensitization.
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Affiliation(s)
- Stefan Nierkens
- Department of Immunotoxicology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
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Atanasković-Marković M, Velicković TC, Gavrović-Jankulović M, Vucković O, Nestorović B. Immediate allergic reactions to cephalosporins and penicillins and their cross-reactivity in children. Pediatr Allergy Immunol 2005; 16:341-7. [PMID: 15943598 DOI: 10.1111/j.1399-3038.2005.00280.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Penicillins and cephalosporins are the most important betalactams inducing IgE-mediated reactions. The safety of administering cephalosporins to penicillin-allergic children is a particular problem, because cephalosporin allergenic determinants have not been properly identified. A study was undertaken to evaluate the frequency of anaphylactic reactions to cephalosporins and penicillins and their cross-reactivity in a pediatric population. A prospective survey was conducted in a group of 1170 children with suspected immediate allergic reactions to cephalosporins and/or penicillins, which were examined during a period of 8 yr. In vivo (skin tests and challenges) and in vitro tests (for specific IgE) were performed with standard concentration of penicillins and cephalosporins. When 1170 children with a clinical history of allergy to penicillins and/or cephalosporins were tested in vivo for immediate hypersensitivity to betalactams, 58.3% cases overall were found to be skin or challenge test positive. Among them, 94.4% patients were positive to penicillins and 35.3% to cephalosporins. The frequency of positive reactions in the in vivo testing was in the range from 36.4% to 88.1% for penicillins and from 0.3% to 29.2% for cephalosporins. However, 31.5% of the penicillin allergic children cross-reacted to some cephalosporin. If a child was allergic to a cephalosporin, the frequency of positive reactions to penicillin was 84.2%. The cross-reactivity between cephalosporins and penicillins varied between 0.3% and 23.9%. The cross-reactivity among different generations of cephalosporins varied between 0% and 68.8%, being the highest for first and second-generation cephalosporins and 0% for third generation cephalosporins. The frequency of immediate allergic reactions to cephalosporins is considerably lower compared to penicillins, and the degree of cross-reactivity between cephalosporins and penicillins depends on the generation of cephalosporins, being higher with earlier generation cephalosporins. The cross-reactivity among cephalosporins is lower compared to cross-reactivity between penicillins and cephalosporins.
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Abstract
Cutaneous adverse drug reactions (ADR) are common and encompass a broad clinical spectrum. Since the skin acts as a signaling organ for ADR, the dermatologist plays a key role in their diagnosis. Only a minor part of cutaneous ADR are due to underlying allergic mechanisms. Among these, delayed-type reactions such as maculopapular exanthems and immediate-type reactions such as urticaria and angioedema predominate. Risk factors for the development of cutaneous allergic ADR may be related to the patient (e.g. certain HLA-types), the drug (e.g. its reactivity), and underlying conditions (e.g. viral infections). Antibiotics, non-steroidal anti-inflammatory agents and anticonvulsive medications are most often reported to be causally related.
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Affiliation(s)
- B Sachs
- Abteilung Pharmakovigilanz, Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn.
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42
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Abstract
Drug-induced airway disease is a significant problem and must be considered in the differential diagnosis. A history of drug intake with a temporal association should raise the physician's suspicion toward a drug-induced cause. Because most of the conditions are amenable to withdrawal of the offending agent, an early diagnosis is essential. Conditions like obliterative bronchiolitis, are usually irreversible, but timely stoppage of the provoking agent can prevent further progression of the disease. Most of the drug reactions are nonallergic and the physician and the patient should be aware of this fact. In view of the constantly-evolving therapies, an active policy to identify and report adverse effects is essential to develop management strategies and treatment recommendations.
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Affiliation(s)
- K Suresh Babu
- Mail Point 810, Level D, Centre Block, Southampton General Hospital, Southampton SO16 6YD, UK.
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Turvey SE, Cronin B, Arnold AD, Dioun AF. Antibiotic desensitization for the allergic patient: 5 years of experience and practice. Ann Allergy Asthma Immunol 2004; 92:426-32. [PMID: 15104194 DOI: 10.1016/s1081-1206(10)61778-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Antibiotic desensitization is an option for patients with suspected IgE-mediated antibiotic allergy when no other alternative exists for treating life-threatening bacterial infections. However, there are limited data describing the outcomes of this procedure with newer, commonly used antibiotics. OBJECTIVE To evaluate the safety and utility of antibiotic desensitization. METHODS We retrospectively reviewed the medical records of all patients undergoing antibiotic desensitization in our institution between November 1996 and November 2001. RESULTS There were a total of 57 desensitizations performed in 21 patients. The mean age of the patients was 22.8 years (range, 1.9-44.5 years) and 15 (71%) were female. Nineteen (90%) of the 21 patients had been diagnosed as having cystic fibrosis. In 33 (100%) of 33 desensitizations to unique antibiotics that occurred during the study period, the indication for desensitization was a history suggestive of an IgE-mediated reaction to the antibiotic and/or a positive skin test result to the antibiotic or a known cross-reactive antibiotic. Desensitizations were performed to 12 different antibiotics. Successful outcomes were achieved in 43 desensitizations (75%). Of the 11 cases (19%) that were terminated due to an allergic reaction, there were no fatalities, intubations, or other aggressive interventions besides the use of epinephrine, antihistamines, and corticosteroids. In 7 of 11 unsuccessful desensitizations, a non-IgE mechanism appeared to be responsible for the allergic reaction. CONCLUSIONS Antibiotic desensitization is a useful option when treating patients with life-threatening infections who must receive antibiotics to which they have an IgE-mediated allergy. These data indicate that in most cases, patients with presumed IgE-mediated antibiotic allergy may safely receive antibiotics after desensitization.
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Affiliation(s)
- Stuart E Turvey
- Division of Immunology, Children's Hospital, Boston, Massachusetts 02115, USA.
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Kohlhäufl M, Weber N, Morresi-Hauf A, Geiger D, Raith H, Häussinger K. [Pulmonary infiltrates with blood eosinophilia in a 62-year-old patient]. Internist (Berl) 2003; 44:1037-41. [PMID: 14671818 DOI: 10.1007/s00108-003-0990-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 62-year-old woman was admitted because of chronic cough and bilateral infiltrates on chest roentgenogram. Additional history revealed that the patient had been taken diclofenac emulgel during the previous 10 years for arthrosis. Diagnostic bronchoscopy showed eosinophilic alveolitis. After ruling out infectious, parasitic or systemic diseases drug-induced eosinophilic pneumonia was diagnosed due to topical diclofenac therapy and subsequent percutaneous drug absorption. No previous case of eosinophilic pneumonia to topical diclofenac was discovered in our review of the literature. The diclofenac therapy was discontinued. Oral corticosteroid therapy cleared bilateral infiltrates on CT scan within seven days. Drug reactions are the most common cause of pulmonary infiltrates with blood eosinophilia and/or eosinophilic alveolitis and should be considered as a differential diagnosis.
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Affiliation(s)
- M Kohlhäufl
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachklinik München-Gauting.
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Atanasković-Marković M, Nestorović B. [Allergy to cephalosporin antibiotics in childhood]. SRP ARK CELOK LEK 2003; 131:127-30. [PMID: 14608875 DOI: 10.2298/sarh0304127a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A particular problem is the safety of administering cephalosporins to penicillin-allergic children, because cephalosporin allergenic determinants have not been properly identified. Cephalosporin antibiotics are widely used to treat common infections and are often the first-line prophylaxis before many types of surgery. So the arm of this study is to determine the frequency of allergic reactions of anaphylactic type to cephalosporins and their cross-reactivity with penicillins. At University Children's Hospital in Belgrade a group of 1,170 children with suspected anaphylactic allergic reaction to penicillins and/or cephalosporins were tested for the last eight years. Skin tests were performed with standard concentration of penicillins and cephalosporins. In children where skin tests were negative single-blind, placebo-controlled challenges were performed. In case of positive skin tests further examinations were interrupted and the children were considered allergic to that drug. The frequency of anaphylactic allergic reactions to cephalosporins is 0.2% to 17%, and depends on cephalosporins generation. The cross-reactivity between cephalosporins and penicillins is 0.1% to 14.5%, and among cephalosporins is 0% to 11.7%.
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Weltman JK, Loriot GB. Molecular modeling of penicilloate anions: an RHF-SCF analysis. J Mol Model 2003; 9:225-9. [PMID: 12764687 DOI: 10.1007/s00894-003-0131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2002] [Accepted: 03/19/2003] [Indexed: 10/26/2022]
Abstract
An ab initio restricted Hartree-Fock self-consistent field (RHF-SCF) analysis of penicilloate anions was performed at the TZV level with GAMESS. Geometry optimization was initialized by the semi-empirical AM1 method followed by optimization at the 6-31++G** level. The total energy obtained was -1116.0997 a.u. for the penicilloate amine, -1115.3164 a.u. for the imine, -1115.2969 a.u. for the enamine and -1115.2017 a.u. for the amine that was deprotonated at the thiazolidine nitrogen. Formation of the free thiolate in the imine and enamine anions by deprotonation of the penicilloate amine is associated with: (1) an increase in total energy (2) an increase in the energy of the highest occupied molecular orbital (HOMO) to that of anti-bonding (3) a decrease in chemical hardness (4) an increase in the chemical potential (5) a more negative Mulliken net charge on the sulfur atom and (6) an increase in the Mulliken atomic population on the former thiazolidine sulfur atom in the HOMO. The RHF-SCF analysis presented here suggests a potential role for the thiolate sulfur of penicilloate anions, especially of the imine, as a chemically reactive soft nucleophile.
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Affiliation(s)
- Joel K Weltman
- Department of Medicine, Brown University School of Medicine, Providence, RI 02912, USA.
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Aihara Y, Ito SI, Kobayashi Y, Yamakawa Y, Aihara M, Yokota S. Carbamazepine-induced hypersensitivity syndrome associated with transient hypogammaglobulinaemia and reactivation of human herpesvirus 6 infection demonstrated by real-time quantitative polymerase chain reaction. Br J Dermatol 2003; 149:165-9. [PMID: 12890212 DOI: 10.1046/j.1365-2133.2003.05368.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Drug-induced hypersensitivity syndrome (HS) is a rare but severe disease with multiorgan failure. Many different precipitating factors have been reported, but the pathophysiology of HS remains unknown. However, the association of the human herpesvirus (HHV) family, particularly of HHV-6, has recently been reported in patients with HS. We report a 14-year-old boy who was diagnosed as having carbamazepine-induced HS based on the clinical course, laboratory data and results of drug-induced lymphocyte stimulation tests. In addition, the reactivation of HHV-6 was demonstrated by real-time quantitative polymerase chain reaction and by significantly increased levels of the specific antibody in his paired sera. Furthermore, transient hypogammaglobulinaemia was detected in the early stage of the disease. In addition, serum levels of interferon-gamma, interleukin (IL)-6, IL-5 and eosinophil cationic protein, which were increased on admission, decreased dramatically after steroid therapy. This is the first report of carbamazepine-induced HS associated with reactivation of HHV-6, transient hypogammaglobulinaemia, increased serum levels of inflammatory cytokines and activated eosinophils. This case might contribute to the understanding of the pathophysiology of HS.
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Affiliation(s)
- Y Aihara
- Department of Paediatrics, Yokohama City University Medical Centre, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
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Sicherer SH. Advances in anaphylaxis and hypersensitivity reactions to foods, drugs, and insect venom. J Allergy Clin Immunol 2003; 111:S829-34. [PMID: 12618751 DOI: 10.1067/mai.2003.152] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This review highlights some of the research advances in anaphylaxis and hypersensitivity reactions to foods, drugs, and insect venom that were reported primarily in this Journal from 2001 to 2002. Among the topics highlighted: Epinephrine injected intramuscularly into the thigh provides the most efficient absorption profile for adults and children; determination of serum IgE antibody-specific food allergen concentrations and atopy patch tests with foods show promise for enhanced diagnostic accuracy; numerous food allergens are now characterized on the molecular level, allowing for improved diagnostic and treatment modalities; the complex immunologic mechanisms underlying drug hypersensitivity reactions are being elucidated; venom immunotherapy improves quality of life for sufferers, and increased venom immunotherapy doses are useful in recalcitrant cases.
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Affiliation(s)
- Scott H Sicherer
- Division of Allergy and Immunology, Mount Sinai School of Medicine, New York, NY, USA
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Posadas SJ, Torres MJ, Mayorga C, Juarez C, Blanca M. Gene expression levels of cytokine profile and cytotoxic markers in non-immediate reactions to drugs. Blood Cells Mol Dis 2002; 29:179-89. [PMID: 12490285 DOI: 10.1006/bcmd.2002.0555] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Drugs can induce IgE mediated or T cell dependent immunological reactions. T cell dependent reactions are poorly understood, although T lymphocytes have been proposed as a protagonist in a number of non-immediate immunological reactions (NIR). The objective was to study in vivo different regulatory and proinflammatory cytokines and cytotoxic markers in patients with NIR to drugs. Twenty patients with NIR after drug intake were classified into two groups: Group A (severe), Stevens-Johnson syndrome and toxic epidermal necrolysis; and Group B (mild), maculopapular exanthema and desquamative exanthema. Another 25 subjects taking the same drugs but without reactions formed a control group. Samples were obtained within 24 hours of the reaction and 30 days later. IL-2, IL-4, IFN, TNF, perforin, granzyme B (GrB), and FasL mRNA expression levels were determined in peripheral blood mononuclear cells by competitive RT-PCR. There were 9 patients in Group A and 11 in Group B. The drugs involved were betalactams (8), anticonvulsants (6), allopurinol (1), sulfamethoxazole (1), amiodarone (1) dypirone (2), and erythromicine+paracetamol (1). At the acute stage there was a high increase of IL-2, IFN, and TNF mRNA expression in both groups vs. controls, perforin and GrB varied in each group with patients in Group A having the highest values, and FasL was only expressed in Group A. Relationships between the cytokines were only significant in Group B (p < 0.05). Only the relation between IFN-gamma and TNF-alpha was significant in Group A. There was a significant correlation between cytotoxic markers in both groups (A: p < 0.001, B: p < 0.01). These data demonstrate the complexity of the Th1 phenotype in NIR after drug intake. In patients with mild NIR, cytokines appear to play a closely related role, whereas cytotoxic markers appear more relevant in severe reactions.
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Sieben S, Kawakubo Y, Al Masaoudi T, Merk HF, Blömeke B. Delayed-type hypersensitivity reaction to paraphenylenediamine is mediated by 2 different pathways of antigen recognition by specific alphabeta human T-cell clones. J Allergy Clin Immunol 2002; 109:1005-11. [PMID: 12063532 DOI: 10.1067/mai.2002.123872] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Allergic contact dermatitis to paraphenylenediamine (PPD) is a frequent cause of morbidity and occupational disability. OBJECTIVE The aim of the study was to characterize T-cell responses to PPD and Bandrowski's base (BB), an autoxidation product of PPD, by using polyclonal and monoclonal T-lymphocyte cultures. METHODS PPD- and BB-driven proliferation of PBMCs and T-cell clones (TCCs) was assessed by means of tritiated thymidine incorporation. Surface markers were studied by means of flow cytometry, and cytokine generation was assessed with an ELISA. RESULTS TCCs, with one exception, were CD4+/CD45RO+, and T-cell receptors were alphabeta+. Three of 6 TCCs expressed Vbeta 16. TCC stimulation was HLA-DP restricted, and TCCs secreted IL-4, IL-5, and marginal levels of IFN-gamma. TCCs reacted to both PPD and BB. Presentation of BB to TCCs was dependent on viable antigen-presenting cells (APCs) pulsed for 4 hours, and fixed APCs failed to stimulate TCCs. Moreover, polyclonal responses to BB were enhanced by metabolically active enzymes, such as cytochrome P450 enzymes. BB has to be metabolized and processed. In contrast, fixation of APCs did not impair their ability to present PPD to TCC, whereas pulsing of APCs with PPD failed to stimulate TCCs. Thus PPD had to be present during the process, and polyclonal stimulation was not enhanced by cytochromes. CONCLUSION These results suggest that PPD itself can be recognized by T cells through a processing-independent pathway, whereas its autoxidation product, BB, required processing and possibly metabolism to stimulate the same TCC. Our data demonstrate that 2 distinct pathways of antigen presentation to activate specific TCCs are involved in the immune response to PPD.
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MESH Headings
- Antigen Presentation/immunology
- Cells, Cultured
- Clone Cells
- Dermatitis, Allergic Contact/etiology
- Dermatitis, Allergic Contact/immunology
- Enzyme-Linked Immunosorbent Assay
- Female
- Flow Cytometry
- HLA-DP Antigens/metabolism
- Humans
- Hypersensitivity, Delayed/chemically induced
- Hypersensitivity, Delayed/immunology
- Interferon-gamma/metabolism
- Interleukin-4/metabolism
- Interleukin-5/metabolism
- Male
- Occupational Diseases/etiology
- Occupational Diseases/immunology
- Phenylenediamines/adverse effects
- Receptors, Antigen, T-Cell, alpha-beta/drug effects
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
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Affiliation(s)
- Sonja Sieben
- Department of Dermatology, University Hospital RWTH Aachen, Germany
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