Fundamental studies on the lymphocyte stimulation test in patients with drug-induced allergic hepatic injury.

Abstract

Table 1 Causative drugs and constituents of groups. Group A: Patients who tested positive LST with SI over 1.81. Group B: Patients who tested negative LST with SI under 1.80. Group C: Normal controls.

Recent status of drug‐induced liver injury

“…The drug‐induced lymphocyte stimulation test (DLST) 8–12 is widely used for various types of drug allergies in Japan, because it can be easily requested to companies for clinical laboratory testing. The test involves exposure of peripheral blood mononuclear cells from the patients to suspected drugs, and a subsequent determination of lymphocyte proliferation using 3 H‐labeled thymidine incorporation 8,12,13 . Although this approach seems not to have gained favor in some countries because of the lack of standardization and reproducibility, 14 DLST is used in the diagnosis of allergic DILI in Japan.…”

“…[1][2][3][4]7 Allergic DILI is characterized by fever, skin rash and eosinophilia. The druginduced lymphocyte stimulation test (DLST) [8][9][10][11][12] is widely used for various types of drug allergies in Japan, because it can be easily requested to companies for clinical laboratory testing. The test involves exposure of peripheral blood mononuclear cells from the patients to suspected drugs, and a subsequent determination of lymphocyte proliferation using 3 H-labeled thymidine incorporation.…”

“…The test involves exposure of peripheral blood mononuclear cells from the patients to suspected drugs, and a subsequent determination of lymphocyte proliferation using 3 H-labeled thymidine incorporation. 8,12,13 Although this approach seems not to have gained favor in some countries because of the lack of standardization and reproducibility, 14 DLST is used in the diagnosis of allergic DILI in Japan. On the other hand, because this test is determined by thymidine incorporation into lymphocytes, we must keep in mind that false positive results may occur when drugs to inhibit DNA synthesis, such as methotrexate, are tested.…”

Drug-induced Liver Injury with Serious Multiform Exudative Erythema following the Use of an Over-the-counter Medication Containing Ibuprofen

“…Therefore, it is clinically important to identify similar drugs with the potential to cause liver injury. DLST are thus a useful tool for identifying culprit drugs causative of DILI, particularly in allergic-type DILI patients (21,22). The results of DLSTs for typical NSAIDs other than ibuprofen in the present case are shown in Table 3.…”

Lymphocyte Transformation Test for Medicinal Herbs Yields False-Positive Results for First-Visit Patients

“…The LTT was considered positive if the SI was 1.8 or greater according to the BML criteria, which have been set up for Western medicines. Other LTT criteria in Japan also adopt a similar SI value as a cutoff point (11,15).…”