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tions of 0.01, 0.1, 1 and 10mg/ml resulted in secretion of Conclusive diagnosis of drug allergy remains a major prob- considerable amounts of IL-5, whereas in the culture wells lem. Currently, the lymphocyte transformation test (LTT) is incubated with PBS the IL-5 concentration was below the the only available in vitro test for detecting drug sensitization detection limit (1.5pg/ml) of the ELISA (Fig. 2). Although at the cellular level, irrespective of the eVector mechanisms with regard to the SI no drug-speciéc proliferation of the and the clinical phenotype of the reaction (3, 4). A common patient's PBMC following incubation with terbutaline was clinical feature of drug allergy is eosinophilia (5), which is observed, IL-5 could be detected in the supernatants of these promoted by interleukin (IL)-5 secretion from antigen-speciéc cultures, namely 33.5, 7.1 and 3.7pg/ml IL-5 at concentrations activated T cells (6). of 0.01, 0.1 and 1mg/ml terbutaline. The IL-5 concentrations We report on a female who developed an erythema exudati- determined in the culture supernatants of the patient's PBMC vum multiforme-like exanthem after receiving fenoterol for incubated with propranolol were below the detection limit of tocolysis due to preterm labour. Lymphocyte sensitization to the ELISA. PBMC of the healthy control did not release fenoterol could be conérmed in vivo by a patch test and in signié cant amounts of IL-5 upon incubation with fenoterol, vitro by a LTT additionally employing the chemically related terbutaline or propranolol. Further on, neither PBMC of the terbutaline and propranolol, which did not induce lymphocyte patient nor of the control secreted signié cant amounts of proliferation. Determination of IL-5 concentrations in the interferon-c when incubated with the three drugs. culture supernatants of the LTT revealed - in addition to fenoterol - lymphocyte reactivity to terbutaline, which could be conérmed in a second patch test. DISCUSSION

Fenoterol-induced Erythema Exudativum Multiforme-like Exanthem: Demonstration of Drug-specific Lymphocyte Reactivity In Vivo and In Vitro