T cell populations propagating in the peripheral blood of patients with drug eruptions

Nishio, Daisuke; Izu, Kunio; Kabashima, Kenji; Tokura, Y.

doi:10.1016/j.jdermsci.2007.05.013

Cited by 49 publications

(30 citation statements)

References 21 publications

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“…The T cell milieu appears to shift from predominantly CD4+, Th2 immunity to CD8+ cytotoxic T cells with disease evolution [44]. High levels of IFN-gamma and TNF-alpha produced by activated T cells last for up to 3 months [45].…”

Section: Laboratory Findingsmentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.

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Section: Laboratory Findingsmentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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“…In this respect, drug allergy more commonly develops in patients with concomitant viral infections. For example, infection with the EpsteinBarr virus (EBV), human herpes virus 6 (HHV-6) and HIV increases the frequency of drug hypersensitivity reactions [10,11].…”

Section: Environmental Factorsmentioning

confidence: 99%

Role of T cells in nonimmediate allergic drug reactions

Rozières

Vocanson

Saïd

et al. 2009

Current Opinion in Allergy &Amp; Clinical Immunology

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Nonimmediate allergic drug reactions are mediated by T cells and mostly affect the skin. Nonimmediate allergic drug reactions comprise several diseases ranging from the frequent and benign maculo-papular exanthema to the severe and rare toxic epidermal necrolysis. Progress in the knowledge of the pathophysiology of nonimmediate allergic drug reactions comes from a better understanding of the mechanisms of drug recognition by T cells and from a careful analysis of the phenotype and functions of CD4+ and CD8+ T cells infiltrating the skin lesions. Recent studies have confirmed that the different clinical forms of nonimmediate allergic drug reactions are associated with distinct types of T cell-mediated skin inflammation. However, CD8+ T cells appear as major effector T cells in most of the nonimmediate allergic drug reactions. Future studies to analyze the early cellular and molecular events leading to the development of the allergic skin reaction will be helpful in order to define diagnostic and therapeutic targets.

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“…In photoallergic drug eruption to AQ, the patients may show an eythematous eruption or lichenoid eruption. Whereas the latter type is mediated by Th1 and Tc1 cells [24,25], the former may be caused by Th2 cells and possibly associated with tissue eosinophilia. The present model may be a mimicry of the former type.…”

Section: Discussionmentioning

confidence: 99%