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- Title
T cell involvement in cutaneous drug eruptions.
- Authors
Hari, Y.; Frutig-Schnyder, K.; Hurni, M.; Yawalkar, N.; Zanni, M. P.; Schnyder, B.; Kappeler, A.; Von Greyerz, S.; Braathen, L. R.; Pichler, W. J.
- Abstract
BackgroundThe most frequent side-effects of drug therapy are skin eruptions. Their pathomechanism is rather unclear. ObjectiveIn this prospective study we investigated the T cell activation and drug specificity in different forms of drug-induced exanthemas from 22 patients. MethodsDuring acute drug allergy, liver parameters and T cell subset activation in the circulation (up-regulation of CD25 and HLA‐DR) were evaluated and skin biopsies of the acute lesion performed. After recovery, the causative drug was identified by lymphocyte transformation (LTT) and scratch-patch tests. ResultsSeventeen of 22 (17/22) patients had maculo-papular exanthema, 4/22 bullous exanthema and 1/22 urticaria. The causative drugs were mainly antibiotics, anti-epileptics and anti-hypertensives. Up-regulation of HLA‐DR on circulating CD4+ and/or CD8+ T cells was detected in 17 patients, being most marked in patients with bullous reactions or hepatic involvement. The LTT was positive in 14/21 analysed and the patch test in 7/15. All patients showed lymphocytic infiltration in the skin biopsy of the acute lesion. Generally CD4+ T cells dominated; a higher percentage of circulating CD8+ T cells was found in patients with bullous skin reactions or hepatic involvement. ConclusionOur data demonstrate activation and drug specificity of T cells in drug-induced skin eruptions. A predominant CD8+ T cell activation leads to more severe (bullous) skin symptoms or liver involvement, while predominant activation of CD4+ cells elicits mainly maculo-papular reactions.
- Subjects
DRUG allergy; T cells; ALLERGIES
- Publication
Clinical & Experimental Allergy, 2001, Vol 31, Issue 9, p1398
- ISSN
0954-7894
- Publication type
Article
- DOI
10.1046/j.1365-2222.2001.01164.x