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T cell involvement in cutaneous drug eruptions
Author(s) -
Hari Y.,
FrutigSchnyder K.,
Hurni M.,
Yawalkar N.,
Zanni M. P.,
Schnyder B.,
Kappeler A.,
Von Greyerz S.,
Braathen L. R.,
Pichler W. J.
Publication year - 2001
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1046/j.1365-2222.2001.01164.x
Subject(s) - medicine , drug allergy , cd8 , skin biopsy , drug , lesion , drug eruption , immunology , allergy , biopsy , pathology , immune system , pharmacology
Background The most frequent side‐effects of drug therapy are skin eruptions. Their pathomechanism is rather unclear. Objective In this prospective study we investigated the T cell activation and drug specificity in different forms of drug‐induced exanthemas from 22 patients. Methods During 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. Results Seventeen 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. Conclusion Our 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.