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Sittiwattanawong P, Kantikosum K, Charoenchaipiyakul K, Pootongkam S, Asawanonda P, Kerr SJ, Thantiworasit P, Sodsai P, Hirankarn N, Klaewsongkram J, Rerknimitr P. In-vivo and ex-vivo tests for culprit drugs identification in severe cutaneous adverse drugs reactions. J Dermatol 2024. [PMID: 38605448 DOI: 10.1111/1346-8138.17207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
Drug causality assessment in severe cutaneous adverse reactions (SCARs) remains challenging. We investigated the usefulness of in-vivo drug patch tests (PT), ex-vivo interferon (IFN)-γ enzyme-linked immunospot (ELISpot) assay, and lymphocyte transformation test (LTT) in 30 SCARs patients within the past 36 months. Drug PT yielded a 20% positivity rate (n = 6), while IFN-γ ELISpot and LTT showed positive rates of 56.67% (n = 17) and 41.38% (n = 12), respectively. Combining the three tests resulted in an overall positive rate of 66.67% (n = 20) of cases. IFN-γ ELISpot offered additional positivity, especially with oxypurinol. Employing a combined diagnostic approach may enhance the chances of obtaining a positive result.
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Affiliation(s)
- P Sittiwattanawong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - K Kantikosum
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - K Charoenchaipiyakul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - S Pootongkam
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - P Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - S J Kerr
- Center for Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Thantiworasit
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - P Sodsai
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Center of Excellence in Immunology and Immune-Mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - N Hirankarn
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Center of Excellence in Immunology and Immune-Mediated Diseases, Chulalongkorn University, Bangkok, Thailand
| | - J Klaewsongkram
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
| | - P Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Center of Excellence for Skin and Allergy Research, Chulalongkorn University, Bangkok, Thailand
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2
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Rogozina O, Ruiz-Fernández C, Martín-López S, Akatbach-Bousaid I, González-Muñoz M, Ramírez E. Organ-specific immune-mediated reactions to polyethylene glycol and polysorbate excipients: three case reports. Front Pharmacol 2024; 14:1293294. [PMID: 38235115 PMCID: PMC10792031 DOI: 10.3389/fphar.2023.1293294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
Drug-related acute pancreatitis (AP), acute interstitial nephritis (AIN) and drug-induced liver injury (DILI) are rare but serious adverse drug reactions (ADRs) that can have life-threatening consequences. Although the diagnosis of these ADRs can be challenging, causality algorithms and the lymphocyte transformation test (LTT) can be employed to help with the diagnosis. In this report, we present 3 cases of drug-related AP, AIN and DILI. The first case involved a patient with AP to lacosamide and to the excipient polysorbate 80 in pantoprazole. The second case involved a patient with DILI secondary to polyethylene glycol (PEG) excipients and amoxicillin-clavulanate. In case 3, AIN was considered to be the result of sensitization to excipients. Diagnoses were made using causality algorithms and the LTT. The LTT is a useful tool for helping diagnose drug-related AP and DILI, and it can be used to identify the specific drug or excipient causing the ADR. These cases highlight the importance of considering PEG and polysorbate excipients in the causality diagnosis of ADRs.
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Affiliation(s)
- Olga Rogozina
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | - Susana Martín-López
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
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3
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Katsuta M, Nobeyama Y, Hirafuku K, Tashiro K, Kimura T, Asahina A. Characteristics of mild and severe apalutamide-related cutaneous adverse events in patients with prostate cancer: A review of the literature. J Dermatol 2024; 51:110-114. [PMID: 37732499 DOI: 10.1111/1346-8138.16972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Apalutamide is an antiandrogen used to treat prostate cancer. Although it sometimes induces mild cutaneous adverse events and occasionally severe ones, clinical differences between severe and mild cases remain unclear. To assess the risks in patients experiencing apalutamide-related cutaneous adverse events (ARCAEs), we aimed to characterize severe and mild ARCAEs in terms of onset time and lymphocyte transformation test (LTT) for apalutamide. We reviewed 41 ARCAE cases: 24 from our institute and 17 from the literature, comprising (i) eight severe cases including six with toxic epidermal necrolysis, one with acute generalized exanthematous pustulosis, and one with drug reaction with eosinophilia and systemic symptoms, and (ii) 33 mild cases. Patients with evere cases developed ARCAEs significantly earlier than patients with mild cases (5.2 vs 9.6 weeks). No severe cases appeared ≥8 weeks after initiation of apalutamide. LTTs showed positive results in two of seven mild cases (28.6%) and four of four severe cases (100.0%). In conclusion, we found that severe ARCAEs are characterized by earlier onset and LTT positivity. Dermatologists and urologists should pay special attention to patients who develop ARCAEs <8 weeks after initiating apalutamide and/or show positive LTT results.
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Affiliation(s)
- Michie Katsuta
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshimasa Nobeyama
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Hirafuku
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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4
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Ruiz-Fernández C, Cuesta R, Martín-López S, Guijarro J, López Gómez de Las Huertas A, Urroz M, Miguel-Berenguel L, González-Muñoz M, Ramírez E. Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study. Pharmaceuticals (Basel) 2023; 16:ph16050720. [PMID: 37242502 DOI: 10.3390/ph16050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 caused the global COVID-19 pandemic and public health crisis, and it led to the rapid development of COVID-19 vaccines, which can cause rare and typically mild hypersensitivity reactions (HRs). Delayed HRs to COVID-19 vaccines have been reported, and the excipients polyethylene glycol (PEG)2000 and polysorbate 80 (P80) are the suspected culprits. Skin patch tests do not help in diagnosing delayed reactions. We aimed to perform lymphocyte transformation tests (LTT) with PEG2000 and P80 in 23 patients with suspected delayed HRs. Neurological reactions (n = 10) and myopericarditis reactions (n = 6) were the most frequent complications. Seventy-eight percent (18/23) of the study patients were admitted to a hospital ward, and the median time to discharge was 5.5 (IQR, 3-8) days. Some 73.9% of the patients returned to baseline condition after 25 (IQR, 3-80) days. LTT was positive in 8/23 patients (5/10 neurological reactions, 2/4 hepatitis reactions and 1/2 rheumatologic reactions). All myopericarditis cases had a negative LTT. These preliminary results indicate that LTT with PEGs and polysorbates is a useful tool for identifying excipients as causal agents in HRs to COVID-19 vaccines and can play an important role in risk stratification in patients with HRs.
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Affiliation(s)
| | - Ricardo Cuesta
- Immunology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain
| | - Susana Martín-López
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Javier Guijarro
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Arturo López Gómez de Las Huertas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Mikel Urroz
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | | | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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5
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Pose K, Tomás-Perez M. Standard dose paracetamol-induced tubulointerstitial nephritis. Eur Ann Allergy Clin Immunol 2023. [PMID: 37133309 DOI: 10.23822/eurannaci.1764-1489.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- K Pose
- Department of Allergy, La Paz University Hospital, Madrid, Spain
| | - M Tomás-Perez
- Department of Allergy, La Paz University Hospital, Madrid, Spain
- Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain
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6
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Saretta F, Tomei L, Mori F, Mayorga C. In vitro diagnostic testing for drug allergy in children. Pediatr Allergy Immunol 2023; 34:e13955. [PMID: 37102390 DOI: 10.1111/pai.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Diagnosing Drug Hypersensitivity Reactions (DHRs) could be a complicated process especially in children, since allergic-like manifestation at this age is more often the expression of concomitant infections rather than a actual DHRs. In vivo tests are usually suggested as a first step; however, prick and intradermal tests could be painful and have shown different sensitivity and specificity among published studies. In some cases, in vivo tests such as Drug Provocation test (DPT) could be even contraindicated. Therefore, the need for in vitro testing is compelling, to add useful information along the diagnostic pathway and to limit the need of DPT. In this review, we analyze the different types of in vitro tests, focusing on those used more widely such as specific IgE and on those that are still for research settings, such as basophil activation test and lymphocyte transformation test, but that have shown some useful diagnostic potential.
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Affiliation(s)
- Francesca Saretta
- Pediatric Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Leonardo Tomei
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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7
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Yang HH, Chang CW, Chen TD. Nivolumab-induced acute tubular injury: A case report. Clin Case Rep 2023; 11:e6991. [PMID: 36911644 PMCID: PMC9992483 DOI: 10.1002/ccr3.6991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/07/2023] [Accepted: 01/23/2023] [Indexed: 03/14/2023] Open
Abstract
Nivolumab belongs to immune checkpoint inhibitors (ICIs). ICIs-induced kidney injury is rare and acute interstitial nephritis (AIN) is the majority. A 58-year-old woman had gastric cancer treated with nivolumab. Her serum creatinine (Cr) increased to 5.94 mg/dL post 2 cycles of nivolumab and co-administered with acemetacin. A kidney biopsy showed acute tubular injury (ATI). Nivolumab rechallenge was done and Cr worsened again. The lymphocyte transformation test (LTT) indicated a strong positive for nivolumab. Although rare, ATI due to ICIs could not be ruled out, and LTT is a tool to identify the culprit.
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Affiliation(s)
- Hui-Hsin Yang
- Department of Pharmacy Chang Gung Memorial Hospital, Taoyuan Taoyuan City Taiwan
| | - Chia-Wen Chang
- Department of Pharmacy Chang Gung Memorial Hospital, Taoyuan Taoyuan City Taiwan
| | - Tai-Di Chen
- Department of Nephrology Chang Gung Memorial Hospital, Linkou Taiwan
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8
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Glässner A, Wurpts G, Röseler S, Yazdi AS, Sachs B. In vitro detection of T cell sensitization by interferon-γ secretion in immediate-type drug allergy. Clin Exp Allergy 2023; 53:222-225. [PMID: 36420733 DOI: 10.1111/cea.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Andreas Glässner
- Research Division, Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Gerda Wurpts
- Department of Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
| | - Stefanie Röseler
- Department of Dermatology and Allergy, University Hospital Aachen, Aachen, Germany.,Department of Pneumology, Allergology, Sleep and Respiratory Medicine, Augustinians Hospital, Cologne, Germany
| | - Amir S Yazdi
- Department of Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
| | - Bernhardt Sachs
- Research Division, Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany.,Department of Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
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9
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Foti C, Calogiuri G, Nettis E, De Marco A, Stingeni L, Hansel K, Di Bona D, Carlucci P, Romita P, Barbaud A. Allergic contact dermatitis from vitamins: A systematic review. Health Sci Rep 2022; 5:e766. [PMID: 36210883 PMCID: PMC9528950 DOI: 10.1002/hsr2.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Aims Vitamins are bioactive compounds naturally found in many different types of food and required by the human body for many biological functions and enzymatic activities. Due to their antioxidant properties, certain vitamin derivatives have been synthesized for inclusion in many cosmetics, thus leading to an increasing incidence of allergic contact dermatitis (ACD) cases. Therefore, the present review may be helpful to provide an insight into the sensitizing role of at least certain vitamins and may also offer possible patch test alternatives for definitive diagnosis. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Literature search regarding ACD cases to vitamins was performed using the Medline, PubMed, Scopus, EMBASE, and Google Scholar databases from January 1940 up to June 2021. Results A total of 4494 articles matched the keywords used for the researched. Records removed before screening included 15 duplicate articles and 3429 not eligible articles (e.g., not written in English, studies on animals, not relevant to the topic). A total of 1050 articles underwent the screening phase and 258 were therefore excluded as they were not primary studies. Subsequentially, 792 articles were considered eligible for the review and 688 of them were finally excluded as they did not report the outcome of interest. Therefore, 104 articles were definitely included in the present review. Conclusion ACD to vitamins is still probably an underestimated issue in cosmetology, as many vitamins are considered "natural" and therefore "safe" ingredients. On the contrary, according to current literature, almost all vitamins contained in topical products are able to induce allergic reactions, with the exception of vitamin B2 and vitamin B9. Patch tests are not standardized, thus leading to difficulties in diagnosis.
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Affiliation(s)
- Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological ClinicUniversity of Bari Aldo MoroBariItaly
| | - Gianfranco Calogiuri
- Temporarily assigned to Pneumology Department for the COVID19 Emergency Civil Hospital Vito FazziLecceItaly
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical ImmunologyUniversity of Bari Aldo MoroBariItaly
| | - Aurora De Marco
- Department of Biomedical Science and Human Oncology, Dermatological ClinicUniversity of Bari Aldo MoroBariItaly
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and SurgeryUniversity of Perugia
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and SurgeryUniversity of Perugia
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation (DETO), School and Chair of Allergology and Clinical ImmunologyUniversity of Bari Aldo MoroBariItaly
| | - Palma Carlucci
- Department of Emergency and Organ Transplantation (DETO), School and Chair of Allergology and Clinical ImmunologyUniversity of Bari Aldo MoroBariItaly
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological ClinicUniversity of Bari Aldo MoroBariItaly
| | - Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP.Sorbonne Université, Hôpital TenonDépartement de dermatologie et allergologieParisFrance
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10
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Kobyashi Y, Adachi T, Arakawa H, Takeuchi M, Inazumi T. Erythema multiforme following vaccination for SARS-CoV-2: Report of a case and review of the literature - Secondary Publication. Australas J Dermatol 2022; 63:e381-e385. [PMID: 36057958 PMCID: PMC9538497 DOI: 10.1111/ajd.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Yuki Kobyashi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Takeya Adachi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan.,Department of Medical Regulatory Science, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.,Keio Frontier Research & Education Collaborative Square (K-FRECS) at Tonomachi, Keio University, Kanagawa, Japan
| | - Hiroki Arakawa
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Mie Takeuchi
- Department of Infection Control and Prevention, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Toyoko Inazumi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
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11
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Puri BK, Monro JA. Detection of 41-kDa bacterial flagellin protein by the lymphocyte transformation test-memory lymphocyte immunostimulation assay. Am J Clin Exp Immunol 2022; 11:72-77. [PMID: 36187894 PMCID: PMC9520187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND/OBJECTIVES Diagnosis of human infection by various species of the bacterial genus Borrelia is mainly reliant on serological testing, polymerase chain reaction (PCR) or culture but such serological tests have been reported to have heterogeneous sensitivities, while Borrelia PCR and culture have been reported as being of modest diagnostic value. It has been suggested that the adjunctive use of the lymphocyte transformation test-memory lymphocyte immunostimulation assay (LTT-MELISA) may be helpful in this regard; however, the clinical usefulness of this assay has been questioned. The Borrelia immunodominant 41-kDa flagellin protein almost always gives rise to a marked human antibody response following infection. It was therefore decided to determine whether the LTT-MELISA detects the human antibody response to this antigen. METHODS Blood samples from consecutive patients with possible borreliosis attending a clinic were independently tested by both Western blots and LTT-MELISA. RESULTS After omitting cases with indeterminate Western blot results and equivocal LTT-MELISA results, multiple linear regression modelling demonstrated that the 41-kDa flagellin immunoglobulin (Ig) M level was predictable from two LTT-MELISA variables (F 2,51 = 5.981, P = 0.005). Similarly, the corresponding 41-kDa IgG model also contained two LTT-MELISA variables (F 2,57 = 3.700, P = 0.031). CONCLUSION It is concluded that the LTT-MELISA appears to be able to detect the response to this antigen.
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Affiliation(s)
| | - Jean A Monro
- Breakspear Medical GroupHemel Hempstead, Hertfordshire, UK
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12
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Semic-Jusufagic A, Ogese MO, Edwards C, Wilkinson M, Nissenbaum C, Lee T, Pirmohamed M, Naisbitt DJ. T-cell-mediated hypersensitivity to lumacaftor and ivacaftor in cystic fibrosis. Pediatr Allergy Immunol 2022; 33:e13815. [PMID: 35754124 DOI: 10.1111/pai.13815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/06/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Aida Semic-Jusufagic
- Paediatric Allergy, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Monday O Ogese
- MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Christopher Edwards
- Cystic Fibrosis Centre, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mark Wilkinson
- Dermatology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Nissenbaum
- Cystic Fibrosis Centre, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tim Lee
- Cystic Fibrosis Centre, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Dean J Naisbitt
- MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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13
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Bose R, Finstad A, Ogbalidet S, Boshra M, Fahim S. Lab-Based Culprit Drug Identification Methods for Cutaneous Drug Eruptions: A Scoping Review. J Cutan Med Surg 2022; 26:291-296. [PMID: 35086349 DOI: 10.1177/12034754211073667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identification of culprit drugs when managing cutaneous drug eruptions is essential. Causality assessment methods (CAMs) have been proposed, including lab-based techniques. However, no consensus guidelines exist. OBJECTIVES To identify and map the functionality and feasibility of lab-based CAMs. METHODS A scoping review was conducted to identify culprit drug identification methods. Publications on lab-based methods were analyzed. Medline, Embase, and Cochrane Central Register of Controlled Trials databases were searched. RESULTS Twenty-five publications met inclusion criteria. Nine lab-based CAMs were studied, including lymphocyte transformation test, cytokine measurement (ELISpot, ELISA, beads array assay), modified IFN-ɣ ELISpot, CellScan, histamine release, granzyme B-ELISpot, intracellular granulysin, lymphocyte toxicity assay, and HLA allele genotyping. Diagnostic accuracy was reported for 8/9 methods. Clinical assessment and operational algorithms were commonly used as validation benchmarks. Lab-based methods were assessed at different phases of a drug eruption including in the acute (18.1%), recovery (27.3%), acute and recovery (27.3%), or an unspecified phase (27.3%). Lymphocyte transformation test (specificity 30% to 100%, sensitivity 27% to 73%) and cytokine measurement (specificity 76% to 100%, sensitivity 20% to 84%) were the most common methods studied. CONCLUSIONS Lab-based CAMs can be low-risk, effective, and complementary of clinical methods. High-quality studies are needed to adequately develop and validate these tools for clinical practice.
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Affiliation(s)
- Reetesh Bose
- 1530066363 Division of Dermatology, University of Ottawa, ON, Canada.,27337 Division of Dermatology, The Ottawa Hospital, Canada
| | | | | | - Mina Boshra
- 12365 Faculty of Medicine, University of Ottawa, ON, Canada
| | - Simone Fahim
- 1530066363 Division of Dermatology, University of Ottawa, ON, Canada.,27337 Division of Dermatology, The Ottawa Hospital, Canada.,12365 Faculty of Medicine, University of Ottawa, ON, Canada
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14
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Aparicio-Soto M, Curato C, Riedel F, Thierse HJ, Luch A, Siewert K. In Vitro Monitoring of Human T Cell Responses to Skin Sensitizing Chemicals-A Systematic Review. Cells 2021; 11:cells11010083. [PMID: 35011644 PMCID: PMC8750770 DOI: 10.3390/cells11010083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Chemical allergies are T cell-mediated diseases that often manifest in the skin as allergic contact dermatitis (ACD). To prevent ACD on a public health scale and avoid elicitation reactions at the individual patient level, predictive and diagnostic tests, respectively, are indispensable. Currently, there is no validated in vitro T cell assay available. The main bottlenecks concern the inefficient generation of T cell epitopes and the detection of rare antigen-specific T cells. Methods: Here, we systematically review original experimental research papers describing T cell activation to chemical skin sensitizers. We focus our search on studies published in the PubMed and Scopus databases on non-metallic allergens in the last 20 years. Results: We identified 37 papers, among them 32 (86%) describing antigen-specific human T cell activation to 31 different chemical allergens. The remaining studies measured the general effects of chemical allergens on T cell function (five studies, 14%). Most antigen-specific studies used peripheral blood mononuclear cells (PBMC) as antigen-presenting cells (APC, 75%) and interrogated the blood T cell pool (91%). Depending on the individual chemical properties, T cell epitopes were generated either by direct administration into the culture medium (72%), separate modification of autologous APC (29%) or by use of hapten-modified model proteins (13%). Read-outs were mainly based on proliferation (91%), often combined with cytokine secretion (53%). The analysis of T cell clones offers additional opportunities to elucidate the mechanisms of epitope formation and cross-reactivity (13%). The best researched allergen was p-phenylenediamine (PPD, 12 studies, 38%). For this and some other allergens, stronger immune responses were observed in some allergic patients (15/31 chemicals, 48%), illustrating the in vivo relevance of the identified T cells while detection limits remain challenging in many cases. Interpretation: Our results illustrate current hardships and possible solutions to monitoring T cell responses to individual chemical skin sensitizers. The provided data can guide the further development of T cell assays to unfold their full predictive and diagnostic potential, including cross-reactivity assessments.
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Affiliation(s)
- Marina Aparicio-Soto
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (M.A.-S.); (C.C.); (F.R.); (H.-J.T.); (A.L.)
| | - Caterina Curato
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (M.A.-S.); (C.C.); (F.R.); (H.-J.T.); (A.L.)
| | - Franziska Riedel
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (M.A.-S.); (C.C.); (F.R.); (H.-J.T.); (A.L.)
- Institute of Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
| | - Hermann-Josef Thierse
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (M.A.-S.); (C.C.); (F.R.); (H.-J.T.); (A.L.)
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (M.A.-S.); (C.C.); (F.R.); (H.-J.T.); (A.L.)
- Institute of Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
| | - Katherina Siewert
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (M.A.-S.); (C.C.); (F.R.); (H.-J.T.); (A.L.)
- Correspondence: ; Tel.: +49-(0)30-18412-57001
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15
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Pose K, Morales-Cabeza C, De Las Vecillas L, González Muñoz M, Feito-Rodriguez M, Fiandor A. Varenicline-induced Erosive Stomatitis: First case report. Contact Dermatitis 2021; 86:317-318. [PMID: 34913173 DOI: 10.1111/cod.14026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine Pose
- Department of Allergy, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | - Ana Fiandor
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Department of Allergy, La Paz University Hospital. Institute for Health Research (IdiPAZ), Madrid, Spain
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16
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Martins JF, Alen Coutinho I, Castro M, Carvalho J, Faria C, Sousa E, Martins P. Remifentanil-Induced Symmetric Drug-Related Intertriginous and Flexural Exanthema: A Diagnosis Challenge in an Intensive Care Patient. J Investig Allergol Clin Immunol 2021; 32:399-401. [PMID: 34779773 DOI: 10.18176/jiaci.0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J F Martins
- Intensive Medicine Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - I Alen Coutinho
- Allergy and Clinical Immunology Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Castro
- Anesthesiology Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Carvalho
- Allergy and Clinical Immunology Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Faria
- Pathological Anatomy Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Sousa
- Intensive Medicine Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - P Martins
- Intensive Medicine Departement, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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17
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Kondo M, Iida S, Umaoka A, Nakanishi T, Matsushima Y, Habe K, Yamanaka K. Lymphocyte transformation test: The multiple positive results turned to all negative after influenza infection. Clin Case Rep 2021; 9:e04806. [PMID: 34552741 PMCID: PMC8443438 DOI: 10.1002/ccr3.4806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Previously positive lymphocyte transformation test (LTT) results changed to negative during influenza infection. As observed in the current article, results of LTT may be influenced by infection; therefore, it is crucial to consider the timing of LTT.
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Affiliation(s)
- Makoto Kondo
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
| | - Shohei Iida
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
| | - Ai Umaoka
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
| | - Takehisa Nakanishi
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
| | | | - Koji Habe
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
| | - Keiichi Yamanaka
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
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18
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Prieto A, Muñoz C, Bogas G, Fernández‐Santamaría R, Palomares F, Mayorga C, Salas M, Doña I, Torres MJ. Single-dose prolonged drug provocation test, without previous skin testing, is safe for diagnosing children with mild non-immediate reactions to beta-lactams. Allergy 2021; 76:2544-2554. [PMID: 33650109 DOI: 10.1111/all.14800] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Mild non-immediate reactions (NIRs) to beta-lactams (BLs) are the most frequent manifestation of drug allergy in children. The diagnostic approach is complex as the utility of skin tests (STs) and lymphocyte transformation tests (LTTs) is controversial. Drug provocation test (DPT) is the gold standard, although no standardized protocols exist. We aimed to investigate the utility of DPT in a unique dose without previous STs, and LTTs in the diagnosis of NIRs to BLs in children. METHODS We prospectively evaluated children 0-14 years old referred to the Regional University Hospital of Málaga during 2017-2020 reporting NIRs to BLs. We performed a DPT with a unique dose followed by regular treatment at home. If positive, STs and LTTs were done after the reaction had disappeared. RESULTS We included 194 children, having 24 (12.4%) a positive DPT. The main culprit was AX (70.1%) followed by AX-clavulanic acid (CLV) (26.8%) and the main symptoms maculopapular exanthema (MPE) (49.5%) and delayed-urticaria (48.5%). A decrease (p = 0.013) in the interval of days between drug administration and onset of symptoms was observed in positive DPT compared with the original reaction (3.5 vs 6 days), with no differences in the overall percentage of MPE and delayed-appearing urticaria (p = 0.551). No severe reactions occurred during DPT. Moreover, STs were positive in 13.33% and LTTs in 52.9%. CONCLUSIONS Single-dose DPT without previous STs is a safe and useful way to assess NIRs to BLs in children. LTT has shown to be useful, confirming a T-cell mechanism involved in these reactions.
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Affiliation(s)
- Ana Prieto
- Paediatrics Unit Hospital Regional Universitario de Malaga Málaga Spain
| | - Candelaria Muñoz
- Paediatrics Unit Hospital Regional Universitario de Malaga Málaga Spain
| | - Gádor Bogas
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy UnitHospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
| | | | - Francisca Palomares
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
| | - Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
| | - Maria Salas
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy UnitHospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
| | - Inmaculada Doña
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy UnitHospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
| | - María José Torres
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy UnitHospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Medicine Department Universidad de Málaga Málaga Spain
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19
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Fernando SL, Li J, Toon C, Weir C. Acute generalized exanthematous pustulosis to a novel oral anticoagulant (apixaban). Ann Allergy Asthma Immunol 2021:S1081-1206(21)00521-4. [PMID: 34343673 DOI: 10.1016/j.anai.2021.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022]
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20
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Schneiderman BA, Yang S, Dipane M, Lu C, McPherson EJ, Schmalzried TP. Periprosthetic Tissue Reaction Independent of LTT Result and Implanted Materials in Total Knee Arthroplasty. J Arthroplasty 2021; 36:2480-2485. [PMID: 33714633 DOI: 10.1016/j.arth.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An allergic reaction may rarely cause a painful or stiff total knee arthroplasty (TKA). However, no consensus diagnostic criteria for TKA immune failure exist. Lymphocyte transformation testing (LTT) measures immune sensitivity to various materials, but its role in diagnosing an allergic reaction to a TKA has not been established. This study compares TKA periprosthetic tissues in a) LTT-positive versus -negative patients and b) patients with conventional CoCrNi versus hypoallergenic implants. METHODS Periprosthetic tissues from 26 revision cases of well-fixed, aseptic, but painful or stiff TKAs were analyzed. Twelve patients LTT positive for nickel (Ni) were matched as a cohort to 6 LTT-negative patients. In 4 patients LTT positive for Ni, tissue from first revision of CoCrNi implants was compared with tissue from subsequent revision of hypoallergenic implants. Histology was evaluated using the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) score. RESULTS No correlation was found between LTT and any ALVAL score component. The mean total ALVAL score was 3.8 ± 1.5 for LTT-negative patients and 3.3 ± 1.2 for LTT-positive patients (P = .44). The mean total ALVAL score at revision of CoCrNi implants was 3.0 ± 1.8 compared with 5.8 ± 0.5 at rerevision of hypoallergenic implants (P = .053). CONCLUSION Periprosthetic TKA tissue reactions were indistinguishable between LTT-positive and -negative patients. LTT does not predict the periprosthetic tissue response. ALVAL scores of hypoallergenic revision implant tissue trended higher than primary CoCrNi implant tissue. A positive LTT may not indicate that a periprosthetic immune reaction is the cause of pain and stiffness after TKA. LEVEL OF EVIDENCE 3, retrospective cohort study.
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Affiliation(s)
| | - Steven Yang
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance CA
| | - Matthew Dipane
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Conrad Lu
- Joint Replacement Institute at St. Vincent Medical Center, Los Angeles CA
| | - Edward J McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Thomas P Schmalzried
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance CA; Joint Replacement Institute at St. Vincent Medical Center, Los Angeles CA
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21
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Liccioli G, Filippeschi C, Giovannini M, Capone M, Oranges T, Barni S, Sarti L, Parronchi P, Mori F. Mycoplasma pneumoniae-associated mucocutaneous disease in children: A case series with allergy workup in a tertiary care paediatric hospital. Clin Exp Allergy 2021; 51:740-744. [PMID: 33675565 DOI: 10.1111/cea.13861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Giulia Liccioli
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Cesare Filippeschi
- Dermatologic Division, Department of Health Science, Meyer Children's Hospital, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Teresa Oranges
- Dermatologic Division, Department of Health Science, Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
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22
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Mori F, Fili L, Sarti L, Capone M, Liccioli G, Giovannini M, Barni S, Novembre EM, Parronchi P. Sensitivity and specificity of lymphocyte transformation test in children with mild delayed hypersensitivity reactions to beta-lactams. Allergy 2020; 75:2696-2699. [PMID: 32392390 DOI: 10.1111/all.14358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Francesca Mori
- Allergy Unit Department of Pediatrics Anna Meyer Children's University Hospital Florence Italy
| | - Lucia Fili
- Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Lucrezia Sarti
- Allergy Unit Department of Pediatrics Anna Meyer Children's University Hospital Florence Italy
| | - Manuela Capone
- Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Giulia Liccioli
- Allergy Unit Department of Pediatrics Anna Meyer Children's University Hospital Florence Italy
| | - Mattia Giovannini
- Allergy Unit Department of Pediatrics Anna Meyer Children's University Hospital Florence Italy
| | - Simona Barni
- Allergy Unit Department of Pediatrics Anna Meyer Children's University Hospital Florence Italy
| | - Elio M. Novembre
- Allergy Unit Department of Pediatrics Anna Meyer Children's University Hospital Florence Italy
| | - Paola Parronchi
- Department of Clinical and Experimental Medicine University of Florence Florence Italy
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23
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Affiliation(s)
- Takahiro Mizuta
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Correspondence to: Takahiro Mizuta, MD, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan.
| | - Aya Tanaka
- Department of Dermatology, Sakai City Medical Center, Osaka, Japan
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24
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Schoon J, Ort MJ, Huesker K, Geissler S, Rakow A. Diagnosis of Metal Hypersensitivity in Total Knee Arthroplasty: A Case Report. Front Immunol 2019; 10:2758. [PMID: 31827473 PMCID: PMC6890602 DOI: 10.3389/fimmu.2019.02758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/11/2019] [Indexed: 12/27/2022] Open
Abstract
Delayed type hypersensitivity (DTH) reactions are considered infrequent complications in arthroplasty, but have been recognized to be associated with devastating morbidity and substantial decrease in quality of life of affected patients. Chronic inflammation of artificial joints and associated loss of peri-implant bone often require revision surgery. Methods for the diagnosis of implant-related DTH are available but infrequently considered to the full extent. Sequential diagnostics based on exclusion of septic complications, local and systemic metal level determination, lymphocyte transformation testing (LTT), and local T cell subset analysis are required for an unequivocal DTH diagnosis. Here, we report on a patient with a history of chronic rheumatoid arthritis and an unfavorable outcome of unilateral knee arthroplasty. This case illustrates pitfalls and difficulties in the course of recurrent inflammation following joint replacement. In the early course, suspicion of low-grade bacterial infection led to three two-stage revisions. Afterwards, the joint was proven to be sterile. However, metal level quantification revealed release of especially cobalt and chromium from the joint, LTT indicated persisting cobalt and nickel sensitization and subset analysis of T cells from the synovium suggested DTH as a root cause for the inflammatory symptoms. This report aims to recommend the depicted diagnostic algorithm as an adequate tool for future DTH detection. Yet, systemic to local subset ratios for effector memory and regulatory T cells should be derived from sufficient patient numbers to establish it as a diagnostic marker. Moreover, future prospects regarding implant-related DTH diagnostics are discussed. Therapeutic options for the portrayed patient are proposed, considering pharmaceutical, cell-therapeutic and surgical aspects. Patients who experience peri-implant inflammation but do not have obvious mechanical or infectious problems remain a diagnostic challenge and are at high risk of being treated inadequately. Since potentially sensitizing materials are regularly used in arthroplasty, it is essential to detect cases of acute DTH-derived inflammation of an artificial joint at early postoperative stages. This would reduce the severity of inflammation-related long-term consequences for affected patients and may avoid unnecessary revision surgery.
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Affiliation(s)
- Janosch Schoon
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Melanie J Ort
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Huesker
- Immunology Department, Institute for Medical Diagnostics, Berlin, Germany
| | - Sven Geissler
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Anastasia Rakow
- Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.,Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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25
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Vílchez-Sánchez F, Domínguez-Ortega J, González Muñoz M, Loli-Ausejo D, Heredia-Revuelto R, Fiandor Román A, Quirce S. Two case reports of delayed-allergic reactions to clindamycin confirmed with a positive lymphocyte transformation test. Eur Ann Allergy Clin Immunol 2019; 52:91-93. [PMID: 31668055 DOI: 10.23822/eurannaci.1764-1489.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Clindamycin is widely used in the prophylaxis and treatment of infections due to its broad spectrum of antimicrobial activity. Hypersensitivity to clindamycin seems to be not very common (less than 1% of drug-allergic reactions) and it mostly appears as delayed T-cell mediated. For the diagnosis, skin testing is considered to be highly sensitive and rather safe, but cutaneous and systemic reactions have been described. Provocation test is considered the gold standard. However, it includes the possibility of severe reactions. We reported two cases of delayed allergic reaction to clindamycin, confirmed with a positive lymphocyte transformation test, showing this in vitro test like a promising diagnostic method because of its usefulness and safety.
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Affiliation(s)
- F Vílchez-Sánchez
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - J Domínguez-Ortega
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,CIBER de Enfermedades Respiratorias, Ciberes, Madrid, Spain
| | | | - D Loli-Ausejo
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - R Heredia-Revuelto
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - A Fiandor Román
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - S Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,CIBER de Enfermedades Respiratorias, Ciberes, Madrid, Spain
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26
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Ogawa E, Shoji K, Miyairi I. Fever as a predictor of positive lymphocyte transformation test. Pediatr Int 2019; 61:951-955. [PMID: 31267605 DOI: 10.1111/ped.13937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/13/2019] [Accepted: 05/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have characterized the clinical manifestations of delayed antibiotic hypersensitivity (AH) diagnosed using objective methods. The lymphocyte transformation test (LTT) is a reproducible method to diagnose type IV hypersensitivity. The purpose of the study was to evaluate the characteristics of delayed AH diagnosed on LTT in children. METHODS We performed a retrospective analysis of patients who were evaluated for AH using LTT at National Center for Child Health and Development, Tokyo, from 2002 to 2014. We extracted patient demographics, type and duration of antibiotics, and clinical characteristics from the medical records. Clinical manifestations were compared between LTT-positive and LTT-negative cases. RESULTS Seventy-five cases for which 101 drugs were tested were included in this study. LTT was positive against 34 drugs in 26 cases. Median age was 5 years (IQR, 1-9 years), and 49% of patients had underlying disease. LTT was performed at a median of 18 days (IQR, 4-59 days) after the suspected episode. The median number of days from the initiation of therapy to the onset of symptoms was 4. Rash was the most common manifestation (89%). Fever (>38°C) was observed in 20 cases (27%). Onset of fever preceded the rash in nine cases (45%), appeared simultaneously in five (25%), appeared afterwards in four (20%), and was unknown in two (10%). Fever was an independent factor associated with AH when comparing LTT-positive and LTT-negative cases (OR, 3.61; 95%CI: 1.03-12.64). CONCLUSIONS Fever was a common presenting symptom of delayed AH in children aged ≤18 years.
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Affiliation(s)
- Eiki Ogawa
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan.,Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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27
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Richards LJ, Streifel A, Rodrigues JM. Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants. Cureus 2019; 11:e5761. [PMID: 31723520 PMCID: PMC6825456 DOI: 10.7759/cureus.5761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Total joint arthroplasties are increasingly common orthopedic procedures performed throughout the United States. Implant failure after these procedures occurs due to a number of causes such as infection or mechanical problems, with metal hypersensitivity being an area of growing interest. The nature and mechanism of a causative relationship between metal hypersensitivity and implant failure have been unclear as it is not known whether implant failure occurs due to a previous metal allergy or metal allergy results from secondary sensitization via metal exposure in existing failing implants. Overall, there appears to be growing support and evidence for metal-hypersensitive patients having worse outcomes with regard to total hip and knee arthroplasties. However, there are conflicting recommendations (outside of Nuss procedures) for pre-implant testing for metal hypersensitivity as testing has not consistently been shown to change patient outcomes.
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Affiliation(s)
- Logan J Richards
- Miscellaneous, University of North Dakota School of Medicine and Health Sciences, Bismarck, USA
| | - Alexandra Streifel
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, USA
| | - Jonathan M Rodrigues
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, USA
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Wicks K, Stretton C, Popple A, Beresford L, Williams J, Maxwell G, Gosling JP, Kimber I, Dearman RJ. T lymphocyte phenotype of contact-allergic patients: experience with nickel and p-phenylenediamine. Contact Dermatitis 2019; 81:43-53. [PMID: 30779159 DOI: 10.1111/cod.13246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/08/2023]
Abstract
BACKGROUND There is considerable interest in understanding the immunological variables that have the greatest influence on the effectiveness of sensitization by contact allergens, particularly in the context of developing new paradigms for risk assessment of novel compounds. OBJECTIVES To examine the relationship between patch test score for three different contact allergens and the characteristics of T cell responses. METHODS A total of 192 patients with confirmed nickel, p-phenylenediamine (PPD) or methylisothiazolinone (MI) allergy were recruited from the Contact Dermatitis Investigation Unit at Salford Royal Hospital. Severity of allergy was scored by the use of patch testing, peripheral blood lymphocytes were characterized for T cell phenotype by flow cytometry, and proliferative activity was characterized by radiolabelled thymidine incorporation. Comparisons were drawn with buffy coat samples from healthy volunteers. RESULTS Patch test positivity for nickel, PPD and MI was associated with changes in the phenotype of peripheral blood T cells: increases in naïve cells, decreases in regulatory T cell frequency and the CD4+ /CD8hi ratio, and increased expression of the skin-homing marker cutaneous lymphocyte antigen (CLA), particularly for those patients with a +++ patch test score. CONCLUSIONS This increased understanding of the characteristics of the T cell responses to contact allergens may provide parameters with which to better measure health risks associated with skin sensitization.
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Affiliation(s)
- Kate Wicks
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Clare Stretton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Amy Popple
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Beresford
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jason Williams
- Contact Dermatitis Investigation Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Gavin Maxwell
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, UK
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca J Dearman
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Cardoso BK, Martins M, Farinha SM, Viseu R, Tomaz E, Inácio F. Late-Onset Rash from Irbesartan: An Immunological Reaction. Eur J Case Rep Intern Med 2019; 6:001128. [PMID: 31293995 PMCID: PMC6601692 DOI: 10.12890/2019_001128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 11/05/2022] Open
Abstract
Cutaneous delayed reactions to antihypertensive drugs have been described in a limited number of case reports but the mechanisms remain mostly unknown. We report the case of a 60-year-old female patient with a 3-week history of an itchy erythematous maculopapular eruption. Although the patient was polymedicated, irbesartan was the most likely culprit. Patch tests and a lymphocyte transformation test to irbesartan were both positive, which was useful for diagnosis and suggested an immunological reaction. No new lesions appeared after irbesartan was stopped or after the introduction of candesartan. Despite its similar chemical structure, candesartan may be tried in patients allergic to irbesartan.
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Affiliation(s)
| | - Marta Martins
- Centro Hospitalar de Setúbal, Serviço de Imunoalergologia, Setúbal, Portugal
| | | | - Regina Viseu
- Centro Hospitalar de Setúbal, Serviço de Imunoalergologia, Setúbal, Portugal
| | - Elza Tomaz
- Centro Hospitalar de Setúbal, Serviço de Imunoalergologia, Setúbal, Portugal
| | - Filipe Inácio
- Centro Hospitalar de Setúbal, Serviço de Imunoalergologia, Setúbal, Portugal
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Marques-Mejías MA, Cabañas R, Ramírez E, Domínguez-Ortega J, Fiandor A, Trigo E, Quirce S, Bellón T. Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach. Front Pharmacol 2019; 10:469. [PMID: 31164819 PMCID: PMC6536588 DOI: 10.3389/fphar.2019.00469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Benznidazole (Bzn) from the nitroimidazole family and nifurtimox from nitrofurans family, are drugs used as first and second line treatment for acute and chronic phases of Chagas disease (CD). Even though skin reactions are frequent, confirmed allergy to Bzn is rare, and there are few cases reported in the literature. Since CD treatment is very restrained, the possibility of cross-reactivity between members of the same and other pharmacological families highlights the importance of an adequate diagnosis that allows alternative treatments in CD and other diseases. We report a series of 31 patients (69% women) referred to our Allergy unit with suspected hypersensitivity to Bzn, twenty three of them with mild reactions and eight of them with severe reactions. LTT with Bzn was performed in 31 patients and in 8 negative controls. LTT was also performed in 25 and 20 of these patients with nifurtimox and Mtn, respectively. Twenty-one out of thirty-one patients were Bzn prick tested, and all were negative. We obtained 2/19 positive results on patch tests to Bzn. LTT with Bzn was positive in 22/31 patients (Sensitivity 75.9% and specificity 100%). The test was considered positive with a stimulation index ≥2. There was a positive result in 7/25 patients for nifurtimox and in 7/20 patients with Mtn. After negative LTT and skin tests, oral provocation was performed in 4/9 patients, all negative. LTT is a safe test that seems to be more useful than skin tests (prick and patch test), particularly in severe reactions, in confirming delayed hypersensitivity to Bzn and detecting cross reactivity with other imidazoles such as Mtn and reactivity to other drugs like nifurtimox. Tests for these drugs need to be included in the workup of patients with hypersensitivity to Bzn in case they are needed as an alternative treatment for CD or to treat other frequent infectious diseases.
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Affiliation(s)
| | - Rosario Cabañas
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,PIELenRed Consortium, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Elena Ramírez
- PIELenRed Consortium, Madrid, Spain.,Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Ana Fiandor
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Elena Trigo
- PIELenRed Consortium, Madrid, Spain.,Tropical Medicine and Travel Health Unit, Department of Internal Medicine, University Hospital La Paz, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Teresa Bellón
- PIELenRed Consortium, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
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Utsunomiya N, Oyama N, Chino T, Utsunomiya A, Hida Y, Hasegawa M. Dietary supplement product composed of natural ingredients as a suspected cause of erythema multiforme: A case report and identification for the confident false positivity of lymphocyte transformation test. J Dermatol 2019; 46:234-239. [PMID: 30623481 DOI: 10.1111/1346-8138.14739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/25/2018] [Indexed: 11/27/2022]
Abstract
Growing and sustainable consumption of health-care products raises a controversial issue underlying the reliability of an in vitro diagnostic approach for adverse skin reaction. This report aimed to: (i) discuss the causative nature of a commercial dietary supplement composed of natural ingredients, particularly an Euglena-containing product, suspicious for erythema multiforme in our exemplified case; and (ii) to address the assay suitability of the lymphocyte transformation test (LTT) for identifying allergic reaction to any ingredient(s) of the product. A Japanese elderly man developed erythema multiforme after intake of a commercially available natural dietary product, whose LTT was positive. His clinical course and positive LTT suggested a provisional diagnosis of natural dietary product-induced eruption. We conducted an inquiry survey for the standard LTT with any commercial products containing Euglena in three major Japanese laboratory services and identified 22 subjects, almost all of whom (21/22, 95.6%) showed a positive LTT for any Euglena-containing products as a suspected causative. Seven normal healthy volunteers who had no intake history of Euglena-containing products showed an equivalent LTT positivity rate with the same product taken by our case; culprit components of the product included Euglena, Angelica keiskei, Barley grass and Chlorella. A cell-free culture system and enzyme-linked immunoassay suggest that the high LTT positivity relies on the non-specific lymphoproliferative activity, and not contamination of uncharacterized microorganisms and endotoxins. Because of the constitutive false positivity of LTT, this assay is unreliable for in vitro supportive diagnosis of adverse skin events caused by dietary products containing particular natural ingredients, as well as herbal materials.
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Affiliation(s)
- Natsuko Utsunomiya
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Noritaka Oyama
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takenao Chino
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Akira Utsunomiya
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yukio Hida
- Clinical Laboratories, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Ljubojević Hadžavdić S, Murtezani I, Bradamante M, Ilic B. Pacemaker allergy. Contact Dermatitis 2018; 76:307-309. [PMID: 28386971 DOI: 10.1111/cod.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/16/2016] [Accepted: 08/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Suzana Ljubojević Hadžavdić
- Department of Dermatology and Venereology, School of Medicine University, University Hospital Centre Zagreb, 10000, Zagreb, Croatia
| | - Imbrane Murtezani
- Department of Dermatology and Venereology, General Hospital Sibenik, 2200, Sibenik, Croatia
| | - Mirna Bradamante
- Department of Dermatology and Venereology, School of Medicine University, University Hospital Centre Zagreb, 10000, Zagreb, Croatia
| | - Brankica Ilic
- Department of Dermatology and Venereology, School of Medicine University, University Hospital Centre Zagreb, 10000, Zagreb, Croatia
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Whritenour J, Ko M, Zong Q, Wang J, Tartaro K, Schneider P, Olson E, Van Volkenburg M, Serrano J, Hayashi P, Fontana R, Chalasani N, Bonkovsky HL. Development of a modified lymphocyte transformation test for diagnosing drug-induced liver injury associated with an adaptive immune response. J Immunotoxicol 2017; 14:31-38. [PMID: 28121193 DOI: 10.1080/1547691x.2016.1254305] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Drug-induced liver injury (DILI) is a growing problem. Diagnostic methods to differentiate DILI caused by an adaptive immune response from liver injury of other causes or to identify the responsible drug in patients receiving multiple drugs, herbals and/or dietary supplements (polypharmacy) have not yet been established. The lymphocyte transformation test (LTT) has been proposed as a diagnostic method to determine if a subject with an apparent hypersensitivity reaction has become sensitized to a specific drug. In this test, peripheral blood mononuclear cells (PBMC) collected from a subject are incubated with drug(s) suspected of causing the reaction. Cell proliferation, measured by the incorporation of [3H]-thymidine into new DNA, is considered evidence of a drug-specific immune response. The objectives of the current studies were to: (1) develop and optimize a modified version of the LTT (mLTT) and (2) investigate the feasibility of using the mLTT for diagnosing DILI associated with an adaptive immune response and identifying the responsible drug. PBMC collected from donors with a history of drug hypersensitivity reactions to specific drugs (manifested as skin rash) were used as positive controls for assay optimization. Following optimization, samples collected from 24 subjects enrolled in the U.S. Drug-Induced Liver Injury Network (DILIN) were tested in the mLTT. Using cytokine and granzyme B production as the primary endpoints to demonstrate lymphocyte sensitization to a specific drug, most samples from the DILIN subjects failed to respond. However, robust positive mLTT responses were observed for two of four samples from three DILIN subjects with hepatitis due to isoniazid (INH). We conclude that the mLTT, as performed here on frozen and thawed PBMC, is not a reliable test for diagnosing DILI caused by all drugs, but that it may be useful for confirming the role of the adaptive immune response in DILI ascribed to INH.
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Affiliation(s)
| | - Mira Ko
- b Drug Safety Research and Development, Pfizer Inc. , La Jolla , CA , USA
| | - Qing Zong
- b Drug Safety Research and Development, Pfizer Inc. , La Jolla , CA , USA
| | - Jianying Wang
- b Drug Safety Research and Development, Pfizer Inc. , La Jolla , CA , USA
| | - Karrie Tartaro
- a Drug Safety Research and Development, Pfizer Inc. , Groton , CT , USA
| | | | - Ellen Olson
- a Drug Safety Research and Development, Pfizer Inc. , Groton , CT , USA
| | | | - Jose Serrano
- c National Institute of Diabetes and Digestive and Kidney Diseases, NIH , Bethesda , MD , USA
| | - Paul Hayashi
- d Department of Internal Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - Robert Fontana
- e Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA
| | - Naga Chalasani
- f Department of Internal Medicine , IUPUI , Indianapolis , IN , USA
| | - Herbert L Bonkovsky
- g Department of Internal Medicine , Wake Forest University School of Medicine , Winston-Salem , NC , USA
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Aoyama Y, Sawada F, Makino E, Shiohara T. Multiple drug sensitization syndrome: A distinct phenotype associated with unrecognized Mycoplasma pneumonia infection. JAAD Case Rep 2017; 3:301-5. [PMID: 28752116 DOI: 10.1016/j.jdcr.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fernandez TD, Mayorga C, Salas M, Barrionuevo E, Posadas T, Ariza A, Laguna JJ, Moreno E, Torres MJ, Doña I, Montañez MI. Evolution of diagnostic approaches in betalactam hypersensitivity. Expert Rev Clin Pharmacol 2017; 10:671-683. [PMID: 28375040 DOI: 10.1080/17512433.2017.1313110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Betalactams are the most widely used drugs against infections and the primary cause of antibiotic hypersensitivity reactions. Reaction patterns for different betalactams have been changing in accordance with consumption trends, and vary among countries. As a consequence, in vivo and in vitro tests have had to change with to keep up with new tendencies. Areas covered: This review is focused on advances in betalactam hypersensitivity diagnosis. Changes in in vivo methods have been limited to the inclusion of new haptens. In contrast, major progress has been achieved for in vitro tests since the 1960s, from the first description of immunoassays, the basophil activation test and the lymphocyte transformation test, to the more sophisticated assays developed in last years. Expert commentary: Issues with diagnosis are related to test sensitivity. In vivo tests show higher sensitivity, however they can be risky, especially in severe and life-threatening reactions. Therefore, we believe that in vitro tests should be the preferred method. Current efforts are under way to enhance their sensitivity. Only multidisciplinary approaches involving immunology, proteomics, nanotechnology and chemistry can help us to fully understand conjugate structures and mechanisms involved in hypersensitivity reactions to betalactams, and consequently lead to advances in in vitro methods.
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Affiliation(s)
- Tahia D Fernandez
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Cristobalina Mayorga
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.,b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Maria Salas
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Esther Barrionuevo
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Teresa Posadas
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Adriana Ariza
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Jose J Laguna
- c Allergy Unit , Hospital de la Cruz Roja , Madrid , Spain
| | - Esther Moreno
- d Allergy Service , University Hospital of Salamanca , Salamanca , Spain
| | - Maria J Torres
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.,e Laboratory of Nanostructures for Diagnosing and Treatment of Allergic Diseases , Andalusian Center for Nanomedicine and Biotechnology - BIONAND , Málaga , Spain
| | - Inmaculada Doña
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Maria I Montañez
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.,e Laboratory of Nanostructures for Diagnosing and Treatment of Allergic Diseases , Andalusian Center for Nanomedicine and Biotechnology - BIONAND , Málaga , Spain
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Kim JH, Kim SH, Yoon MG, Jung HM, Park HS, Shin YS. A case of occupational contact dermatitis caused by N-acetylcysteine. Contact Dermatitis 2017; 74:373-4. [PMID: 27133626 DOI: 10.1111/cod.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ji Hye Kim
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 16499 Suwon, South Korea
| | - Seung-Hyun Kim
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 16499 Suwon, South Korea
| | - Moon-Gyeong Yoon
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 16499 Suwon, South Korea
| | - Hye-Min Jung
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 16499 Suwon, South Korea
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 16499 Suwon, South Korea
| | - Yoo Seob Shin
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 16499 Suwon, South Korea
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Demir S, Gelincik A, Akdeniz N, Aktas-Cetin E, Olgac M, Unal D, Ertek B, Coskun R, Colakoğlu B, Deniz G, Buyukozturk S. Usefulness of In Vivo and In Vitro Diagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin. Allergy Asthma Immunol Res 2017; 9:347-359. [PMID: 28497922 PMCID: PMC5446950 DOI: 10.4168/aair.2017.9.4.347] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 12/21/2022]
Abstract
Purpose Reports evaluating diagnosis and cross reactivity of quinolone hypersensitivity have revealed contradictory results. Furthermore, there are no reports investigating the cross-reactivity between gemifloxacin (GFX) and the others. We aimed to detect the usefulness of diagnostic tests of hypersensitivity reactions to quinolones and to evaluate the cross reactivity between different quinolones including the latest quinolone GFX. Methods We studied 54 patients (mean age 42.31±10.39 years; 47 female) with 57 hypersensitivity reactions due to different quinolones and 10 nonatopic quinolone tolerable control subjects. A detailed clinical history, skin test (ST), and single-blind placebo-controlled drug provocation test (SBPCDPT), as well as basophil activation test (BAT) and lymphocyte transformation test (LTT) were performed with the culprit and alternative quinolones including ciprofloxacin (CFX), moxifloxacin (MFX), levofloxacin (LFX), ofloxacin (OFX), and GFX. Results The majority (75.9%) of the patients reported immediate type reactions to various quinolones. The most common culprit drug was CFX (52.6%) and the most common reaction type was urticaria (26.3%). A quarter of the patients (24.1%) reacted to SBPCDPTs, although their STs were negative; while false ST positivity was 3.5% and ST/SBPCDPTs concordance was only 1.8%. Both BAT and LTT were not found useful in quinolone hypersensitivity. Cross-reactivity was primarily observed between LFX and OFX (50.0%), whereas it was the least between MFX and the others, and in GFX hypersensitive patients the degree of cross-reactivity to the other quinolones was 16.7%. Conclusions These results suggest that STs, BAT, and LTT are not supportive in the diagnosis of a hypersensitivity reaction to quinolone as well as in the prediction of cross-reactivity. Drug provocation tests (DPTs) are necessary to identify both culprit and alternative quinolones.
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Affiliation(s)
- Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nilgun Akdeniz
- Department of Immunology, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Esin Aktas-Cetin
- Department of Immunology, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Muge Olgac
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Derya Unal
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Belkis Ertek
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Raif Coskun
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bahattin Colakoğlu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Konvinse KC, Phillips EJ, White KD, Trubiano JA. Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity. Curr Opin Infect Dis 2016; 29:561-576. [PMID: 27753687 PMCID: PMC5113146 DOI: 10.1097/qco.0000000000000323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs. RECENT FINDINGS Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge. Although patch and intradermal testing are specific for the diagnosis of immune-mediated ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex-vivo diagnostics, especially enzyme-linked immunospot, has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous immune-mediated ADRs. SUMMARY In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct 'allergy label' is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction, is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T cell-mediated ADRs via personalized approaches, including human leukocyte antigen-typing, may pave future pathways to safer antimicrobial prescribing guidelines.
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Affiliation(s)
- Katherine C Konvinse
- aDepartment of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA bInstitute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia cDepartment of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA dDepartment of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA eDepartment of Infectious Diseases, Austin Hospital, Victoria, Australia fDepartment of Infectious Diseases, Alfred Hospital, Victoria, Australia gDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia hDepartment of Medicine, University of Melbourne, Victoria, Australia
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Fage SW, Muris J, Jakobsen SS, Thyssen JP. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. Contact Dermatitis 2016; 74:323-45. [PMID: 27027398 DOI: 10.1111/cod.12565] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 11/29/2022]
Abstract
Exposure to titanium (Ti) from implants and from personal care products as nanoparticles (NPs) is common. This article reviews exposure sources, ion release, skin penetration, allergenic effects, and diagnostic possibilities. We conclude that human exposure to Ti mainly derives from dental and medical implants, personal care products, and foods. Despite being considered to be highly biocompatible relative to other metals, Ti is released in the presence of biological fluids and tissue, especially under certain circumstances, which seem to be more likely with regard to dental implants. Although most of the studies reviewed have important limitations, Ti seems not to penetrate a competent skin barrier, either as pure Ti, alloy, or as Ti oxide NPs. However, there are some indications of Ti penetration through the oral mucosa. We conclude that patch testing with the available Ti preparations for detection of type IV hypersensitivity is currently inadequate for Ti. Although several other methods for contact allergy detection have been suggested, including lymphocyte stimulation tests, none has yet been generally accepted, and the diagnosis of Ti allergy is therefore still based primarily on clinical evaluation. Reports on clinical allergy and adverse events have rarely been published. Whether this is because of unawareness of possible adverse reactions to this specific metal, difficulties in detection methods, or the metal actually being relatively safe to use, is still unresolved.
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Affiliation(s)
- Simon W Fage
- Department of Dermato-Venereology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Joris Muris
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
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Wang LF, Wu J, Zheng C, Li SL, Huang RR, Zhang JK. Long-Term Fever After Hallux Valgus Surgery Secondary to Titanium Allergy: A Case Report and Review of the Literature. J Foot Ankle Surg 2015; 55:1282-1286. [PMID: 26234925 DOI: 10.1053/j.jfas.2015.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Indexed: 02/03/2023]
Abstract
We present the case of a patient who had experienced a fever of unknown cause for >7 months after surgical treatment for hallux valgus. A patch test revealed a positive reaction to a titanium alloy. All symptoms subsequently disappeared after we removed the implanted titanium screws. Histopathologic examination of the tissue surrounding the screws showed macrophage infiltration in the tissue. For >1 year after removal of the titanium screws, the patient's body temperature remained <37°C. These results support a diagnosis of titanium allergy in our patient. To the best of our knowledge, a long-term fever caused by an allergic reaction to mini-titanium screws of such a small size has not been reported. A review of 16 cases of titanium allergy reported in the published data confirmed that titanium allergy is extremely rare and that the clinical symptoms can vary. Titanium allergy should be suspected when a patient presents with a fever of unknown cause, delayed wound healing, dermatitis, or impaired fracture healing after internal fixation with titanium materials. A patch test for titanium or the lymphocyte transformation test could offer guidance for the clinical diagnosis of titanium allergy. Finally, we recommend that all patients should be asked whether they have a history of an allergy to any metal before surgery.
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Affiliation(s)
- Long-Feng Wang
- Surgeon, Air Force General Hospital of Anhui Medical University, Beijing, China; Surgeon, Postgraduate School of Anhui Medical University, Hefei City, China
| | - Ji Wu
- Surgeon, Air Force General Hospital of Anhui Medical University, Beijing, China; Professor, Postgraduate School of Anhui Medical University, Hefei City, China.
| | - Chao Zheng
- Surgeon, Air Force General Hospital of Anhui Medical University, Beijing, China; Assistant Professor, Air Force General Hospital of Anhui Medical University, Beijing, China
| | - Song-Lin Li
- Surgeon, Air Force General Hospital of Anhui Medical University, Beijing, China
| | - Rong-Rong Huang
- Surgeon, Air Force General Hospital of Anhui Medical University, Beijing, China
| | - Jin-Kang Zhang
- Surgeon, Air Force General Hospital of Anhui Medical University, Beijing, China
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Trautmann A, Seitz CS, Stoevesandt J, Kerstan A. Aminopenicillin-associated exanthem: lymphocyte transformation testing revisited. Clin Exp Allergy 2015; 44:1531-8. [PMID: 25323308 DOI: 10.1111/cea.12437] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/19/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The lymphocyte transformation test (LTT) has been promoted as in-vitro test for diagnosis of drug hypersensitivity. For determination of statistical LTT sensitivity, series of patients with clinically uniform reactions followed by complete drug hypersensitivity work-up are mandatory. Assessment of LTT specificity requires control patients who tolerated exposure to the drug studied. OBJECTIVE To prospectively determine the diagnostic value of the LTT in a clinically and diagnostically well-defined series of patients. METHODS Patients with exanthematous skin eruptions after ampicillin (AMP) intake were included in this study. After exclusion or confirmation of delayed-onset allergic AMP hypersensitivity by skin and provocation testing, two independent LTTs were performed: one standard LTT and a modified LTT with additional anti-CD3/anti-CD28 monoclonal antibody stimulation. RESULTS By testing, delayed-onset allergic AMP hypersensitivity was diagnosed in 11 patients and definitely ruled out in 26. The standard LTT reached a diagnostic sensitivity of 54.5% while the modified LTT yielded 72.7%. However, the methodical test modification resulted in a decline of specificity from 92.3% (standard LTT) to 76.9%. CONCLUSIONS AND CLINICAL RELEVANCE In cases of AMP-associated exanthems, the diagnostic value of the LTT compared with routine allergy testing is limited. When evaluating such exanthems, provocation testing remains the gold standard. Delayed reading of intradermal skin tests remains most useful to avoid positive provocation reactions.
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Affiliation(s)
- A Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
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Abstract
Cellular ex vivo assays have a broad range of applications in patient care and clinical studies, especially when they are standardized and highly sensitive. As compared to analyses by molecular genetics such as the single nucleotide polymorphism (SNP) testing, they are usually more global. These assays partly mimic the in vivo situation, relying on a complex interaction of various immune cells. For example, they can be used to determine modulation of alloresponses by treatment or underlying disease, diagnose and quantify primary and secondary cellular immunodeficiency, follow-up vaccination responses, measure adoptive transfer of virus-specific immunity via hematopoietic stem cell or liver transplantation, assess allergy, antimicrobial immunity and also rare effector/memory cells directed against tumor antigens. This review will first shortly describe various cellular in vitro methods and then present applications, summarizing some own studies performed within the last 18 years.
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Affiliation(s)
- M Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, Essen, 45147, Germany
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Spoerri I, Scherer K, Michel S, Link S, Bircher AJ, Heijnen IAFM. Detection of nickel and palladium contact hypersensitivity by a flow cytometric lymphocyte proliferation test. Allergy 2015; 70:323-7. [PMID: 25443647 DOI: 10.1111/all.12553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/30/2022]
Abstract
We established a flow cytometric lymphocyte proliferation test (LPT) for the detection of nickel (Ni) and palladium (Pd) sensitization. Eighty-one consecutive patients with an indication for patch test (PT) were tested by LPT with Ni (NiSO4 ) and Pd (Na2 PdCl4 and PdCl2 ) salts. The imprecision of the LPT was low (coefficient of variation 7.2%). Using PT as a diagnostic reference, the sensitivity and specificity of LPT were 74.4% and 80% for NiSO4 , 74.4% and 78.3% for Na2 PdCl4 , and 57.2% and 85.4% for PdCl2 , respectively. For both Ni and Pd, the likelihood ratio for a positive PT markedly increased with increasing LPT value. With medical history as a reference, the sensitivity and specificity were 40.6% and 82.1% for LPT and 59.4% and 89.7% for PT, respectively. Combination of LPT and PT resulted in a higher specificity of 95%, albeit lower sensitivity of 34.4%. In conclusion, flow cytometric LPT represents a reliable and useful method for the detection of Ni and Pd sensitization. LPT values correlate with PT results and, when used in combination with PT, increase test specificity.
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Affiliation(s)
- I. Spoerri
- Research Group of Dermatology; Department of Biomedicine; University Hospital Basel; University of Basel; Basel Switzerland
| | - K. Scherer
- Allergy Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - S. Michel
- Allergy Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - S. Link
- Medical Immunology, Laboratory Medicine; University Hospital Basel; Basel Switzerland
| | - A. J. Bircher
- Allergy Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - I. A. F. M. Heijnen
- Medical Immunology, Laboratory Medicine; University Hospital Basel; Basel Switzerland
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Popple A, Williams J, Maxwell G, Gellatly N, Dearman RJ, Kimber I. The lymphocyte transformation test in allergic contact dermatitis: New opportunities. J Immunotoxicol 2015; 13:84-91. [PMID: 25655136 DOI: 10.3109/1547691x.2015.1008656] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Allergic contact dermatitis (ACD) is driven by the activation and proliferation of allergen-specific memory T-lymphocytes and is currently diagnosed by patch testing with a selected panel of chemical allergens. The lymphocyte transformation test (LTT) can be used to monitor ex vivo T-lymphocyte responses to antigens, including contact allergens. The LTT is not viewed as being an alternative to patch testing, but it does seek to reflect experimentally skin sensitization to specific chemicals. The LTT is based on stimulation in vitro of antigen-driven T-lymphocyte proliferation. That is, exposure in culture of primed memory T-lymphocytes to the relevant antigen delivered in an appropriate configuration will provoke a secondary response that reflects the acquisition of skin sensitization. The technical aspects of this test and the utility of the approach for investigation of immune responses to contact allergens in humans are reviewed here, with particular emphasis on further development and refinement of the protocol. An important potential application is that it may provide a basis for characterizing those aspects of T-lymphocyte responses to contact allergens that have the greatest influence on skin sensitizing potency and this will be considered in some detail.
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Affiliation(s)
- Amy Popple
- a Faculty of Life Sciences , University of Manchester , Manchester , UK
| | - Jason Williams
- b Contact Dermatitis Investigation Unit , Salford Royal NHS Foundation Trust , Salford , Manchester , UK , and
| | - Gavin Maxwell
- c Unilever Safety and Environmental Assurance Centre, Colworth Science Park , Sharnbrook , Bedford , UK
| | - Nichola Gellatly
- c Unilever Safety and Environmental Assurance Centre, Colworth Science Park , Sharnbrook , Bedford , UK
| | - Rebecca J Dearman
- a Faculty of Life Sciences , University of Manchester , Manchester , UK
| | - Ian Kimber
- a Faculty of Life Sciences , University of Manchester , Manchester , UK
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Puri BK, Segal DRM, Monro JA. Diagnostic use of the lymphocyte transformation test-memory lymphocyte immunostimulation assay in confirming active Lyme borreliosis in clinically and serologically ambiguous cases. Int J Clin Exp Med 2014; 7:5890-5892. [PMID: 25664127 PMCID: PMC4307574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/13/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to carry out an independent evaluation of the proposition that the lymphocyte transformation test-memory lymphocyte immunostimulation assay (LTT-MELISA) may be diagnostically useful in the confirmation of active Lyme borreliosis in clinically and serologically ambiguous cases. Blood samples from 54 patients consecutively presenting to a British center with clinical suspicion of Lyme borreliosis were tested for this disease by immunoglobulin M (IgM) and immunoglobulin G (IgG) Western blots and by LTT-MELISA. Forty-five of these patients had Western blot results which were negative for both IgM and IgG by the criteria of the Centers for Disease Control and Prevention (CDC); of these patients, 19 (42%) were LTT-MELISA-positive. Two of the patients who had IgM positive results by the CDC criteria were LTT-MELISA-negative. It is concluded that, for putative European-acquired Lyme borreliosis infections, it would be sensible to carry out both the LTT-MELISA and Western blot assay.
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Affiliation(s)
- Basant K Puri
- Department of Medicine, Imperial College London, Hammersmith HospitalLondon W12 0HS, UK
| | - Daniel RM Segal
- Breakspear Medical GroupHemel Hempstead, Hertfordshire, HP2 4FD, UK
| | - Jean A Monro
- Breakspear Medical GroupHemel Hempstead, Hertfordshire, HP2 4FD, UK
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Abstract
Titanium has gained immense popularity and has successfully established itself as the material of choice for dental implants. In both medical and dental fields, titanium and its alloys have demonstrated success as biomedical devices. Owing to its high resistance to corrosion in a physiological environment and the excellent biocompatibility that gives it a passive, stable oxide film, titanium is considered the material of choice for intraosseous use. There are certain studies which show titanium as an allergen but the resources to diagnose titanium sensivity are very limited. Attention is needed towards the development of new and precise method for early diagnosis of titanium allergy and also to find out the alternative biomaterial which can be used in place of titanium. A review of available articles from the Medline and PubMed database was done to find literature available regarding titanium allergy, its diagnosis and new alternative material for titanium.
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Affiliation(s)
- Manish Goutam
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Chandu Giriyapura
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Sunil Kumar Mishra
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Siddharth Gupta
- Department of Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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von Baehr V. The lymphocyte transformation test for the diagnosis of Lyme borreliosis could fill a gap in the difficult diagnostics of borreliosis. Clin Microbiol Infect 2014; 20:O1155-6. [PMID: 25040111 DOI: 10.1111/1469-0691.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas P. Clinical and diagnostic challenges of metal implant allergy using the example of orthopaedic surgical implants: Part 15 of the Series Molecular Allergology. ACTA ACUST UNITED AC 2014; 23:179-185. [PMID: 26120529 PMCID: PMC4479460 DOI: 10.1007/s40629-014-0023-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/29/2014] [Indexed: 11/25/2022]
Abstract
The focus of this review are allergic reactions to orthopaedic-surgical metal implants. The spectrum of metal implant associated potential allergic reactions encompasses eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Despite the growing number of respective publications the topic „metal implant allergy“ remains a diagnostic challenge. Initially, differential diagnoses should always be excluded in cooperation with surgery collegues. It is recommended to perform a combined evaluation of medical history, clinical findings, patch testing and histology. The lymphocyte transformation test (LTT) can indicate metal sensitization, but it needs careful interpretation. Allergists can provide a substantial contribution to this interdisciplinary topic.
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Affiliation(s)
- Peter Thomas
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstraße 9-11, 80337 Munich, Germany
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von Baehr V, Doebis C, Volk HD, von Baehr R. The lymphocyte transformation test for borrelia detects active lyme borreliosis and verifies effective antibiotic treatment. Open Neurol J 2012; 6:104-12. [PMID: 23091571 PMCID: PMC3474945 DOI: 10.2174/1874205x01206010104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 11/24/2022] Open
Abstract
Borrelia-specific antibodies are not detectable until several weeks after infection and even if they are present, they are no proof of an active infection. Since the sensitivity of culture and PCR for the diagnosis or exclusion of borreliosis is too low, a method is required that detects an active Borrelia infection as early as possible. For this purpose, a lymphocyte transformation test (LTT) using lysate antigens of Borrelia burgdorferi sensu stricto, Borrelia afzelii and Borrelia garinii and recombinant OspC was developed and validated through investigations of seronegative and seropositive healthy individuals as well as of seropositive patients with clinically manifested borreliosis. The sensitivity of the LTT in clinical borreliosis before antibiotic treatment was determined as 89,4% while the specificity was 98,7%. In 1480 patients with clinically suspected borreliosis, results from serology and LTT were comparable in 79.8% of cases. 18% were serologically positive and LTT-negative. These were mainly patients with borreliosis after antibiotic therapy. 2.2% showed a negative serology and a positive LTT result. Half of them had an early erythema migrans. Following antibiotic treatment, the LTT became negative or borderline in patients with early manifestations of borreliosis, whereas in patients with late symptoms, it showed a regression while still remaining positive. Therefore, we propose the follow-up monitoring of dis-seminated Borrelia infections as the main indication for the Borrelia-LTT.
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Affiliation(s)
- Volker von Baehr
- Institute for Medical Diagnostics, Immunology Department, Nicolaistrasse 22, 12247 Berlin
| | - Cornelia Doebis
- Institute for Medical Diagnostics, Immunology Department, Nicolaistrasse 22, 12247 Berlin
| | - Hans-Dieter Volk
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin
| | - Rüdiger von Baehr
- Institute for Medical Diagnostics, Immunology Department, Nicolaistrasse 22, 12247 Berlin
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Kim MH, Shim EJ, Jung JW, Sohn SW, Kang HR. A case of allopurinol-induced fixed drug eruption confirmed with a lymphocyte transformation test. Allergy Asthma Immunol Res 2012; 4:309-10. [PMID: 22950038 PMCID: PMC3423606 DOI: 10.4168/aair.2012.4.5.309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/22/2011] [Accepted: 01/11/2012] [Indexed: 12/03/2022]
Abstract
Allopurinol is one of the causative drugs that induce fixed drug eruption (FDE). The lymphocyte transformation test (LTT) is a safe and reliable diagnostic procedure for drug allergy, but is reported to be rarely positive in patients with FDE. In the current case, we performed an LTT and successfully confirmed allopurinol as the offending drug. This case report suggests that an LTT should be an optional diagnostic tool for FDE or delayed reaction due to allopurinol.
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Affiliation(s)
- Min-Hye Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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