RATIONALE: Lymphocyte Transformation Test (LTT) allows to determine the specific proliferation of concrete cell populations in response to a particular drug. The sensitivity of this test to evaluate immediate allergic reactions to clavulanic acid (CLV) had not been evaluated. We had previously demonstrated that specific immunological recognition of CLV antigenic determinants (AD) increases the sensitivity in basophil activation tests. Therefore, our goal was to evaluate the T-cell recognition of synthetic CLV AD using LTT. METHODS: Different analogs of two potential ADs of CLV (AD-I and AD-II) were synthetized. Peripheral blood was obtained from 11 patients with immediate reactions to CLV and from 10 healthy subjects. Proliferation of different cell populations (CD3 + , CD4 + , CD8 + , CD4 + Th2 and Treg cells) was analyzed by flow cytometry using Carboxyfluorescein-succinimidyl ester (CFSE). Results were presented as Proliferation Index (PI). RESULTS: Higher PI was obtained after the inclusion of each analog in CD3 + and CD4 + cells in CLV patients compared with controls, especially in CD4 + Th2 cells, suggesting its important role in these diseases. Only a 27% of allergic patients showed a positive proliferation result (PI>2) when cells were cultured with CLV. Interestingly, when AD-I was included, 45,5% of patients gave positive results and, when the two ADs were included, positivity increased to 63,7%. No proliferation was observed in controls with any of the stimuli. CONCLUSIONS: The inclusion of different CLV ADs improves LTT sensitivity in immediate allergic reactions to this drug mimicking the response at acute phase. Interestingly, some patients recognize both AD or only one, suggesting a different recognition pattern. 285 Genetic Association between CYSLTR2 Polymorphisms and Nonsteroidal Antiinflammatory Drugs-induced urticaria/ angioedema
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