Document Detail

Induction of accelerated reactions to amoxicillin by T-cell effector mechanisms.
MedLine Citation:
PMID:  23535091     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Although allergic drug reactions have been considered to be immediate (IgE mediated) or delayed (T-cell effector mechanisms), accelerated reactions have also been defined; however, they have not been sufficiently studied.
OBJECTIVE: To study the mechanisms involved in accelerated reactions to amoxicillin.
METHODS: We monitored the response in 3 patients who had an accelerated reaction to amoxicillin. A T-cell effector response was searched after a Drug Provocation Test. Symptoms were recorded after initiation of the reaction, and sequential samples were taken at different intervals after challenge. Skin biopsy specimens were also taken, and a lymphocyte transformation test (LTT) was performed.
RESULTS: After the drug provocation test, all 3 patients had a positive response within 2 to 6 hours of drug administration, with full expression at 6 hours, requiring corticoids and antihistamine treatment. They had generalized erythema with facial angioedema but no cardiovascular or respiratory symptoms. Monitoring of the response revealed the presence in the skin of CD4 and CD8 lymphocytes with increased expression of homing and cell activation markers. Immunohistochemistry revealed a perivascular mononuclear cell infiltrate with activated CD4 and CD8 cells expressing perforin and granzyme B. No tryptase release was detected in either the affected tissue or the peripheral blood. The LTT result was positive in all 3 patients.
CONCLUSION: We found that accelerated reactions to β-lactams are mediated by effector T cells. The increase in different T-cell markers and a positive LTT result to amoxicillin, in parallel with the occurrence of symptoms after challenge, support this mechanism.
Enrique Gómez; Natalia Blanca-Lopez; Maria Salas; Gabriela Canto; Paloma Campo; Maria J Torres; Cristobalina Mayorga; Miguel Blanca
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology     Volume:  110     ISSN:  1534-4436     ISO Abbreviation:  Ann. Allergy Asthma Immunol.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503580     Medline TA:  Ann Allergy Asthma Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  267-73     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain.
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