Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from bedside to bench and back

Clinical and Translational Allergy

Pascal Demoly²  Anca Mirela Chiriac²  Liesbeth Gilissen³  Rik Schrijvers¹ 

[1] Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium;Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, 75013, France;Department of Dermatology, University Hospitals Leuven, Leuven, Belgium

关键词: Regulatory T-cells;    Tissue-resident memory T-cells;    Abacavir hypersensitivity syndrome;    Pharmacogenomics;    Lymphocyte proliferation assay;    Altered self-repertoire model;    Hapten;    pi-concept;    Drug hypersensitivity;    Drug allergy;   

Others  :  1223804
DOI  :  10.1186/s13601-015-0073-8

 received in 2015-05-12, accepted in 2015-07-29,  发布年份 2015

【 摘 要 】

Drug hypersensitivity reactions (DHR) have been present since the advent of drugs. In particular T-cell mediated delayed-type hypersensitivity reactions represent a heterogeneous clinical entity with a diverse pathogenesis and result in a considerable burden of morbidity and mortality not only driven by the reactions themselves but also by the use of alternatives which are sometimes less effective or even more dangerous. Diagnostic procedures rely on clinical history, skin testing and potential provocation testing, whereas validated in vitro diagnostic procedures are still lacking for most of them. Recent work in the field of pharmacogenomics combined with basic scientific research has provided insights in the pathogenesis of abacavir and carbamazepine hypersensitivities linked with certain human leucocyte antigen risk alleles. Nevertheless, important scientific questions on how other DHR arise and how host-drug interactions occur, remain unanswered. Recent work indicates an intricate relation between host, drug and pathogens in severe cutaneous and systemic reactions and provides more insights in the role of regulatory T-cells and viral reactivation in these reactions. In this review we focus on type IV delayed-type DHR, and address recent advances in the pathogenesis, pharmacogenomics, and diagnosis of these reactions with an emphasis on the understandings arising from basic research.

【 授权许可】

   
2015 Schrijvers et al.

【 图 表 】

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