Allergy Asthma Immunol Res.  2012 Sep;4(5):251-263. 10.4168/aair.2012.4.5.251.

Immunologic Evaluation of Drug Allergy

• Gomez E
• Torres MJ
• Mayorga C
• Blanca M

• KMID: 2167043
• DOI: http://doi.org/10.4168/aair.2012.4.5.251

Abstract

Hypersensitivity drug reactions (HDR) consist of an individual abnormal response with the involvement of the immunological system. In addition to specific immunological mechanisms where specific antibodies or sensitised T cells participate, release of inflammatory mediators by non-specific immunological recognition may also occur. Within this category are one of the most common groups of drugs, the non-steroidal anti-inflammatory drugs. In addition to chemical drugs new emerging ones with an increasing protagonism are biological agents like humanised antibodies and others. For IgE dependent reactions both in vivo and in vitro tests can be used for the immunological evaluation. Sensitivity of these is not optimal and very often a drug provocation test must be considered for knowing the mechanism involved and/or establishing the diagnosis. For non-immediate reactions also both in vivo and in vitro tests can be used. Sensitivity for in vivo tests is generally low and in vitro tests may be needed for the immunological evaluation. Immunohistochemical studies of the affected tissue enable a more precise classification of non-immediate reactions. The monitorization of the acute response of the reactions has given clues for understanding these reactions and has promising results for the future of the immunological evaluation of HDR.

Keyword

Drug; immunology; inflammatory cell; diagnosis

MeSH Terms

Antibodies
Biological Agents
Drug Hypersensitivity
Hypersensitivity
Immunoglobulin E
T-Lymphocytes
Antibodies
Biological Agents
Immunoglobulin E

Figure

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  Fig. 1 Different clinical manifestation and the immunological mechanism involved in immediate and non-immediate reactions to drugs.

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  Fig. 2 Immunological mechanism in immediate and non-immediate reactions to drugs.

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  Fig. 3 Haematoxylin-eosin and for immunohistochemical stains of lymphocyte subpopulations (CD3, CD4, CD8, CD45RO), skin homing receptor (CLA), and cytotoxic markers (Granzyme B and Perforin) in skin biopsies from different delayed reactions, taken during the acute phase.

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