Immunogenetics of drug-induced skin blistering disorders. Part II: Synthesis

Pemphigus pathogenesis: problems and prospects

Provides the survey of most prospective trends of research of the pathogenesis of the true acantholytic pemphigus. Cites key results of studies of factors of genetic predisposition to the development of this bullous dermatosis. Highlights problems of studies of the role of antiself antibodies and self-antigens in pemphigus pathogenesis. Represents the apoptolyse theory, explaining mechanisms of the loss of link between keratinocytes. Discusses issues of the cellular regulation of autoimmune reactions at acantholytic pemphigus.

[Pharmacogenetics]

Allergic reactions to drugs belong to the group of B-reactions, which are characterized not only by the pharmacologic profile of the drug but also by individual risk factors. Pharmacogenetic approaches facilitate identifying these risk factors. The most important example for Caucasian patients is NIDR (non-immediate drug reaction) to abacavir. Chinese patients possess risk factors for NIDR to allopurinol and anticonvulsants and the HLA locus on chromosome 6. Another potentially important area is assessing risk factors to prevent allergic reactions to antibiotics, especially with regard to the effective treatment of MRSA.

Immunogenetics of drug-induced skin blistering disorders. Part I: Perspective

The overall immunopathogenesis relevant to a large series of disorders caused by a drug or its associated hyperimmune condition is discussed based upon the examination of the genetics of severe drug-induced bullous skin problems (sporadic idiosyncratic adverse events, including Stevens-Johnson syndrome and toxic epidermal necrolysis). An overarching pharmacogenetic schema is proposed. Immune cognition and early-effector processes are focused upon and a challenging synthesis around systems evolution is explained by a variety of projective analogies. Etiology, human leukocyte antigen-B, immune stability, dysregulation, pharmacomimicry, viruses and an aggressive ethnically differentiated 'karmic' response are discussed.