Lymphocyte Transformation Test in Drug-Induced Toxic Epidermal Necrolysis

Abstract

Lymphocyte transformation tests (LTT) to drugs remain widely used in drug reactions, despite controversies about their real usefulness. We tested the lymphocytes of 12 patients recovering from a drug-induced Toxic epidermal necrolysis (TEN). There was no difference between the amounts of thymidine incorporated when patients’ lymphocytes were cultivated with culprit or innocent drugs. In both situations the lymphocytes from patients reacted like the lymphocytes from controls cultivated with the same panel of drugs. These negative results do not exclude that a hypersensitivity reaction may play a role in the physiopathology of TEN. Anyhow, they clearly indicate that testing lymphocyte transformation to drugs has no practical value in the diagnosis of TEN.

Toxic Epidermal Necrolysis with Extensive Mucosal Erosions of the Gastrointestinal and Respiratory Tracts

“…The pathogenesis of drug-induced TEN is poorly understood [1][2][3][4][5]9], Immunologic mechanisms [10][11][12][13] as well as autoimmune mechanisms [14] have been suggested to be involved in the drug reaction. Among drugs most frequently connected with TEN are sulphonamides and penicillins among antibiotics, pyrazolone derivatives (phenylbutazone and oxyphenylbutazone) among non-steroidal anti-inflam matory drugs (NSAID), phenytoin preparations among anticonvulsants and barbiturates.…”

Drug Hypersensitivity

“…In the case of beta-lactams, for immediate and non immediate reactions, the sensitivity was 64.5% and 57.9%, respectively and the specificity was 92.8% (Luque et al, 2001;Pichler & Tilch, 2004). In a retrospective analysis of patients with adverse drug reactions, the LTT sensitivity was seen to depend also on the drug involved in the reaction (Nyfeler & Pichler, 1997;Roujeau et al, 1985) and the sensitivity might significantly improve when LTT is performed at the optimal time (Kano et al, 2007). This timing could vary depending on the clinical manifestations, since it has been shown that LTT should be performed within one week for patients with MPE and SJS/TEN whereas 5-8 weeks is optimal for patients with DRESS (Kano et al, 2007).…”

Hypersensitivity reactions to HIV therapy

“…However, the use of patch testing is not widespread, and even with ABC hypersensitivity, the predictive value of testing has not been ascertained. Lymphocyte transformation tests have also been used with a number of drugs associated with hypersensitivity in HIV patients including SMX [119], ABC [25] and nevirapine [52]. However, this is very much a research tool, and not a clinically validated test.…”