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2015 ; 5
(ä): 31
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Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from
bedside to bench and back
#MMPMID26339470
Schrijvers R
; Gilissen L
; Chiriac AM
; Demoly P
Clin Transl Allergy
2015[]; 5
(ä): 31
PMID26339470
show ga
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.