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Awad A, Mouhtouris E, Nguyen-Robertson CV, Holmes N, Chua KY, Copaescu A, James F, Goh MS, Aung AK, Godfrey DI, Philips EJ, Gibson A, Almeida CF, Trubiano JA. Blister fluid as a cellular input for ex vivo diagnostics in drug-induced severe cutaneous adverse reactions improves sensitivity and explores immunopathogenesis. J Allergy Clin Immunol Glob 2022; 1:16-21. [PMID: 37780076 PMCID: PMC10509900 DOI: 10.1016/j.jacig.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/28/2021] [Indexed: 10/03/2023]
Abstract
Background Drug-induced severe cutaneous adverse reactions (SCARs) are presumed T-cell-mediated hypersensitivities associated with significant morbidity and mortality. Traditional in vivo testing methods, such as patch or intradermal testing, are limited by a lack of standardization and poor sensitivity. Modern approaches to testing include measurement of IFN-γ release from patient PBMCs stimulated with the suspected causative drug. Objective We sought to improve ex vivo diagnostics for drug-induced SCARs by comparing enzyme-linked immunospot (ELISpot) sensitivities and flow cytometry-based intracellular cytokine staining and determination of the cellular composition of separate samples (PBMCs or blister fluid cells [BFCs]) from the same donor. Methods ELISpot and flow cytometry analyses of IFN-γ release were performed on donor-matched PBMC and BFC samples from 4 patients with SCARs with distinct drug hypersensitivity. Results Immune responses to suspected drugs were detected in both the PBMC and BFC samples of 2 donors (donor patient 1 in response to ceftriaxone and case patient 4 in response to oxypurinol), with BFCs eliciting stronger responses. For the other 2 donors, only BFC samples showed a response to meloxicam (case patient 2) or sulfamethoxazole and its 4-nitro metabolite (case patient 3). Consistently, flow cytometry revealed a greater proportion of IFN-γ-secreting cells in the BFCs than in the PBMCs. The BFCs from case patient 3 were also enriched for memory, activation, and/or tissue recruitment markers over the PBMCs. Conclusion Analysis of BFC samples for drug hypersensitivity diagnostics offers a higher sensitivity for detecting positive responses than does analysis of PBMC samples. This is consistent with recruitment (and enrichment) of cytokine-secreting cells with a memory/activated phenotype into blisters.
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Affiliation(s)
- Andrew Awad
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
| | - Effie Mouhtouris
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
| | - Catriona Vi Nguyen-Robertson
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Natasha Holmes
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
| | - Kyra Y.L. Chua
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
| | - Ana Copaescu
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
| | - Fiona James
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
| | - Michelle S. Goh
- Department of Dermatology, Alfred Health, Melbourne, Australia
| | - Ar Kar. Aung
- Department of General Medicine, Alfred Health, Melbourne, Australia
| | - Dale I. Godfrey
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Elizabeth J. Philips
- The Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
| | - Andrew Gibson
- The Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
| | - Catarina F. Almeida
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jason A. Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Australian Registry of Severe Cutaneous Adverse Reactions (AUS-SCAR)
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Dermatology, Alfred Health, Melbourne, Australia
- Department of General Medicine, Alfred Health, Melbourne, Australia
- The Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
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