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Journal Compilation © 2020 Acta Dermato-Venereologica. doi: 10.2340/00015555-3465 Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a type of severe adverse drug reaction associated with multi-organ involvement and the reactivation of human herpesvirus 6 (HHV-6) (1, 2). Previously, we reported that CD134 (OX40), an HHV-6 cellular receptor (3), was preferentially upregulated on CD4+ T cells in patients with DIHS during the acute stage of the condition, compared with its expression level in other drug eruptions, such as maculopapular exanthema (MPE) and Stevens-Johnson syndrome (SJS) (4). We suggested that the upregulation of CD134 might be necessary for CD4+ T cells to become permissive to HHV-6 entry, and that CD134-expressing CD4+ T cells might facilitate the spread of HHV-6 in DIHS (4). In this study, we found that OX40L, the ligand of CD134, is also preferentially expressed on peripheral blood mononuclear cells (PBMCs) in patients with DIHS. Moreover, the percentage of CD134-expressing CD4+ T cells was correlated with laboratory parameters associated with Th2-type immune responses, such as the serum thymus and activation-regulated chemokine (TARC) level and the eosinophil count. Since OX40–OX40L ligation is known to promote Th2 differentiation (5), CD134 might function not only as an HHV-6 receptor (3), but also as a driver of Th2-type immune responses in DIHS.

acta dermato-venereologica

Correlation Between Expression of CD134, a Human Herpesvirus 6 Cellular Receptor, on CD4+ T cells and Th2-type Immune Responses in Drug-induced Hypersensitivity Syndrome/Drug Reaction with Eosinophilia and Systemic Symptoms