View More View Less
  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
Restricted access

Purchase article

USD  $25.00

1 year subscription (Individual Only)

USD  $1,070.00

A gyógyszermellékhatások felismerése és a tüneteket kiváltó gyógyszer oki szerepének bizonyítása komoly felkészültséget igényel. E közlemény célja a gyógyszerallergiás reakciók diagnosztikai lehetőségeinek rövid áttekintése és a lymphocytatranszformációs teszt gyógyszer-hiperszenzitivitási reakciókban való bizonyító szerepének bőrgyógyászati szempontok szerinti értékelése. A lymphocytatranszformációs teszt azon a megfigyelésen alapul, hogy a gyógyszerrel való első találkozáskor kialakult antigénspecifikus T-sejtek osztódni kezdenek az antigénnel való in vitro megismételt találkozás után. A szenzibilizációt az osztódó T-sejtekbe történő 3 H-timidin-beépülés mértéke jelzi. A hatóanyag-specifikus T-sejtek szinte mindig részt vesznek a gyógyszerallergiás reakciókban, ezért a vizsgálat előnye, hogy sok gyógyszernél és különböző immunreakciók eseteiben egyaránt jól alkalmazható. Hátránya a munkaigényesség, valamint az, hogy specificitásának és szenzitivitásának bizonyításához hiányoznak a széles körű, nagy beteganyagon elvégzett tanulmányok. Emiatt a teszt nem egyértelműen elfogadott a gyógyszerallergia igazolására. Hiányosságai ellenére azonban, jobb prediktív értékű egyéb vizsgálatok hiányában, a lymphocytatranszformációs tesztnek fontos szerepe van a gyógyszerallergiák diagnosztizálása terén.

  • Pichler, W. J.: Drug hypersensitivity. Karger, Basel, 2007.

    Pichler W. J. , '', in Drug hypersensitivity , (2007 ) -.

  • Czirják L.: Klinikai Immunológia. Medicina Könyvkiadó Zrt., Budapest, 2006.

    Czirják L. , '', in Klinikai Immunológia , (2006 ) -.

  • Barbaud, A., Goncalo, M., Bruynzeel, D. és mtsa: European Society of Contact Dermatitis: Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Contact Dermat., 2001, 45 , 321–328.

    Bruynzeel D. , 'European Society of Contact Dermatitis: Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions ' (2001 ) 45 Contact Dermat. : 321 -328.

    • Search Google Scholar
  • Choquet-Kastylevsky, G., Vial, T., Descotes, J.: Drug allergy diagnosis in humans: possibilities and pitfalls. Toxicology, 2001, 158 , 1–10.

    Descotes J. , 'Drug allergy diagnosis in humans: possibilities and pitfalls ' (2001 ) 158 Toxicology : 1 -10.

    • Search Google Scholar
  • Sanz, M. L., Gamboa, P. M., Garcia-Aviles, C. és mtsa: Drug hypersensitivities: which room for biological tests? Allerg. Immunol. (Paris), 2005, 37 , 230–235.

    Garcia-Aviles C. , 'Drug hypersensitivities: which room for biological tests? ' (2005 ) 37 Allerg. Immunol. (Paris) : 230 -235.

    • Search Google Scholar
  • Primeau, M. N., Adkinson, N. F. Jr.: Recent advances in the diagnosis of drug allergy. Curr. Opin. Allergy Clin. Immunol., 2001, 1 , 337–341.

    Adkinson N. F. , 'Recent advances in the diagnosis of drug allergy ' (2001 ) 1 Curr. Opin. Allergy Clin. Immunol. : 337 -341.

    • Search Google Scholar
  • Yoshimura, T., Kurita, C., Yamazaki, F. és mtsai: Lymphocyte stimulation test with tetrazolium-based colorimetric assay for diagnosis of drug-induced allergic hepatitis. Biol. Pharm. Bull., 1994, 17 , 921–926.

    Yamazaki F. , 'Lymphocyte stimulation test with tetrazolium-based colorimetric assay for diagnosis of drug-induced allergic hepatitis ' (1994 ) 17 Biol. Pharm. Bull. : 921 -926.

    • Search Google Scholar
  • Yoshimura, T., Kurita, C., Hayata, M. és mtsa: Diagnosis of drug allergy by the lymphocyte stimulation test with the MTT [3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay. Biol. Pharm. Bull., 1993, 16 , 686–689.

    Hayata M. , 'Diagnosis of drug allergy by the lymphocyte stimulation test with the MTT [3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay ' (1993 ) 16 Biol. Pharm. Bull. : 686 -689.

    • Search Google Scholar
  • Szabó I., Gonda A., Bakos B. és mtsai: Lymphoblast transformation colorimetry in the diagnosis of drug hypersensitivity. Orv. Hetil., 1998, 139 , 2379–2382.

    Bakos B. , 'Lymphoblast transformation colorimetry in the diagnosis of drug hypersensitivity ' (1998 ) 139 Orv. Hetil. : 2379 -2382.

    • Search Google Scholar
  • Renz, H., Becker, W. M., Bufe, A. és mtsai: In vitro allergy diagnosis. Guideline of the German Society of Asthma and Immunology in conjunction with the German Society of Dermatology. J. Dtsch. Dermatol. Ges., 2006, 4 , 72–85.

    Bufe A. , 'In vitro allergy diagnosis. Guideline of the German Society of Asthma and Immunology in conjunction with the German Society of Dermatology ' (2006 ) 4 J. Dtsch. Dermatol. Ges. : 72 -85.

    • Search Google Scholar
  • Ott, H., Baron, J., Merk, H. F.: In vitro allergy testing. Hautarzt, 2006, 57 , 502–508.

    Merk H. F. , 'In vitro allergy testing ' (2006 ) 57 Hautarzt : 502 -508.

  • Pichler, W. J., Tilch, J.: The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Allergy, 2004, 59 , 809–820.

    Tilch J. , 'The lymphocyte transformation test in the diagnosis of drug hypersensitivity ' (2004 ) 59 Allergy : 809 -820.

    • Search Google Scholar
  • Merk, H. F., Abel, J., Baron, J. M. és mtsa: Molecular pathways in dermatotoxicology. Toxicol. Appl. Pharmacol., 2004, 195 , 267–277.

    Baron J. M. , 'Molecular pathways in dermatotoxicology ' (2004 ) 195 Toxicol. Appl. Pharmacol. : 267 -277.

    • Search Google Scholar
  • Wolkenstein, P., Tan, C., Lecoeur, S. és mtsai: Covalent binding of carbamazepine reactive metabolites to P450 isoforms present in the skin. Chem. Biol. Interact., 1998, 113 , 39–50.

    Lecoeur S. , 'Covalent binding of carbamazepine reactive metabolites to P450 isoforms present in the skin ' (1998 ) 113 Chem. Biol. Interact. : 39 -50.

    • Search Google Scholar
  • Wu, Y., Sanderson, J. P., Farrell, J. és mtsai: Activation of T cells by carbamazepine and carbamazepine metabolites. J. Allergy Clin. Immunol., 2006, 118 , 233–241.

    Farrell J. , 'Activation of T cells by carbamazepine and carbamazepine metabolites ' (2006 ) 118 J. Allergy Clin. Immunol. : 233 -241.

    • Search Google Scholar
  • Naisbitt, D. J., Gordon, S. F., Pirmohamed, M. és mtsai: Antigenicity and immunogenicity of sulphamethoxazole: demonstration of metabolism-dependent haptenation and T-cell proliferation in vivo. Br. J. Pharmacol., 2001, 133 , 295–305.

    Pirmohamed M. , 'Antigenicity and immunogenicity of sulphamethoxazole: demonstration of metabolism-dependent haptenation and T-cell proliferation in vivo ' (2001 ) 133 Br. J. Pharmacol. : 295 -305.

    • Search Google Scholar
  • Sachs, B., Erdmann, S., Al-Masaoudi, T. és mtsa: In vitro drug allergy detection system incorporating human liver microsomes in chlorazepate-induced skin rash: drug-specific proliferation associated with interleukin-5 secretion. Br. J. Dermatol., 2001, 144 , 316–320.

    Al-Masaoudi T. , 'In vitro drug allergy detection system incorporating human liver microsomes in chlorazepate-induced skin rash: drug-specific proliferation associated with interleukin-5 secretion ' (2001 ) 144 Br. J. Dermatol. : 316 -320.

    • Search Google Scholar
  • Naisbitt, D. J., Farrell, J., Wong, G. és mtsai: Characterization of drug-specific T cells in lamotrigine hypersensitivity. J. Allergy Clin. Immunol., 2003, 111 , 1393–1403.

    Wong G. , 'Characterization of drug-specific T cells in lamotrigine hypersensitivity ' (2003 ) 111 J. Allergy Clin. Immunol. : 1393 -1403.

    • Search Google Scholar
  • Troger, U., Brandt, W., Rose, W.: Development of a pulmonary phenytoin-associated hypersensitivity reaction despite concomitant dexamethasone and prednisolone administration. Int. J. Clin. Pharmacol. Ther., 2000, 38 , 452–456.

    Rose W. , 'Development of a pulmonary phenytoin-associated hypersensitivity reaction despite concomitant dexamethasone and prednisolone administration ' (2000 ) 38 Int. J. Clin. Pharmacol. Ther. : 452 -456.

    • Search Google Scholar
  • Warrington, R. J., Tse, K. S.: Lymphocyte transformation studies in drug hypersensitivity. Can. Med. Assoc. J., 1979, 120 , 1089–1094.

    Tse K. S. , 'Lymphocyte transformation studies in drug hypersensitivity ' (1979 ) 120 Can. Med. Assoc. J. : 1089 -1094.

    • Search Google Scholar
  • Barna, B. P., Gogate, P., Deodhar, S. D. és mtsa: Lymphocyte transformation and radioallergosorbent tests in drug hypersensitivity. Am. J. Clin. Pathol., 1980, 73 , 172–176.

    Deodhar S. D. , 'Lymphocyte transformation and radioallergosorbent tests in drug hypersensitivity ' (1980 ) 73 Am. J. Clin. Pathol. : 172 -176.

    • Search Google Scholar
  • Berg, P. A., Brattig, N., Diao, G. J. és mtsa: Diagnose arzneimittel-bedingter Nebenwirkungen mit der Hilfe des Lymphocytentransformationstest. Allergologie, 1983, 6 , 77–81.

    Diao G. J. , 'Diagnose arzneimittel-bedingter Nebenwirkungen mit der Hilfe des Lymphocytentransformationstest ' (1983 ) 6 Allergologie : 77 -81.

    • Search Google Scholar
  • Nyfeler, B., Pichler, W. J.: The lymphocyte transformation test for the diagnosis of drug allergy: sensitivity and specificity. Clin. Exp. Allergy, 1997, 27 , 175–181.

    Pichler W. J. , 'The lymphocyte transformation test for the diagnosis of drug allergy: sensitivity and specificity ' (1997 ) 27 Clin. Exp. Allergy : 175 -181.

    • Search Google Scholar
  • Hari, Y., Frutig-Schnyder, K., Hurni, M. és mtsai: T cell involvement in cutaneous drug eruptions. Clin. Exp. Allergy, 2001, 31 , 1398–1408.

    Hurni M. , 'T cell involvement in cutaneous drug eruptions ' (2001 ) 31 Clin. Exp. Allergy : 1398 -1408.

    • Search Google Scholar
  • Schnyder, B., Pichler, W. J.: Skin and laboratory tests in amoxicillin- and penicillin-induced morbilliform skin eruption. Clin. Exp. Allergy, 2000, 30 , 590–595.

    Pichler W. J. , 'Skin and laboratory tests in amoxicillin- and penicillin-induced morbilliform skin eruption ' (2000 ) 30 Clin. Exp. Allergy : 590 -595.

    • Search Google Scholar
  • Luque, I., Leyva, L., Jose Torres, M. és mtsai: In vitro T-cell responses to beta-lactam drugs in immediate and nonimmediate allergic reactions. Allergy, 2001, 56 , 611–618.

    Jose Torres M. , 'In vitro T-cell responses to beta-lactam drugs in immediate and nonimmediate allergic reactions ' (2001 ) 56 Allergy : 611 -618.

    • Search Google Scholar
  • Naisbitt, D. J., Britschgi, M., Wong, G. és mtsai: Hypersensitivity reactions to carbamazepine: characterization of the specificity, phenotype, and cytokine profile of drug-specific T cell clones. Mol. Pharmacol., 2003, 63 , 732–741.

    Wong G. , 'Hypersensitivity reactions to carbamazepine: characterization of the specificity, phenotype, and cytokine profile of drug-specific T cell clones ' (2003 ) 63 Mol. Pharmacol. : 732 -741.

    • Search Google Scholar
  • Kardaun, S. H., de Monchy, J. G.: Acute generalized exanthematous pustulosis caused by morphine, confirmed by positive patch test and lymphocyte transformation test. J. Am. Acad. Dermatol., 2006, 55 , S21–23.

    Monchy J. G. , 'Acute generalized exanthematous pustulosis caused by morphine, confirmed by positive patch test and lymphocyte transformation test ' (2006 ) 55 J. Am. Acad. Dermatol. : S21 -23.

    • Search Google Scholar
  • Anliker, M. D., Wuthrich, B.: Acute generalized exanthematous pustulosis due to sulfamethoxazol with positive lymphocyte transformation test (LTT). J. Investig. Allergol. Clin. Immunol., 2003, 13 , 66–68.

    Wuthrich B. , 'Acute generalized exanthematous pustulosis due to sulfamethoxazol with positive lymphocyte transformation test (LTT) ' (2003 ) 13 J. Investig. Allergol. Clin. Immunol. : 66 -68.

    • Search Google Scholar
  • Buettiker, U., Keller, M., Pichler, W. J. és mtsai: Oral prednisolone induced acute generalized exanthematous pustulosis due to corticosteroids of group A confirmed by epicutaneous testing and lymphocyte transformation tests. Dermatology, 2006, 213 , 40–43.

    Pichler W. J. , 'Oral prednisolone induced acute generalized exanthematous pustulosis due to corticosteroids of group A confirmed by epicutaneous testing and lymphocyte transformation tests ' (2006 ) 213 Dermatology : 40 -43.

    • Search Google Scholar
  • Beltraminelli, H. S., Lerch, M., Arnold, A. és mtsai: Acute generalized exanthematous pustulosis induced by the antifungal terbinafine: case report and review of the literature. Br. J. Dermatol., 2005, 152 , 780–783.

    Arnold A. , 'Acute generalized exanthematous pustulosis induced by the antifungal terbinafine: case report and review of the literature ' (2005 ) 152 Br. J. Dermatol. : 780 -783.

    • Search Google Scholar
  • Neukomm, C. B., Yawalkar, N., Helbling, A. és mtsa: T-cell reactions to drugs in distinct clinical manifestations of drug allergy. J. Investig. Allergol. Clin. Immunol., 2001, 11 , 275–284.

    Helbling A. , 'T-cell reactions to drugs in distinct clinical manifestations of drug allergy ' (2001 ) 11 J. Investig. Allergol. Clin. Immunol. : 275 -284.

    • Search Google Scholar
  • Matsushima, H., Takayanagi, N., Sakamoto, T. és mtsai: A case of drug-induced interstitial pneumonitis in rheumatoid arthritis treated with bucillamine. Nihon Kokyuki Gakkai Zasshi, 2001, 39 , 55–59.

    Sakamoto T. , 'A case of drug-induced interstitial pneumonitis in rheumatoid arthritis treated with bucillamine ' (2001 ) 39 Nihon Kokyuki Gakkai Zasshi : 55 -59.

    • Search Google Scholar
  • Woltsche, M., Woltsche-Kahr, I., Roeger, G. M. és mtsai: Sulfasalazine-induced extrinsic allergic alveolitis in a patient with psoriatic arthritis. Eur. J. Med. Res., 2001, 6 , 495–497.

    Roeger G. M. , 'Sulfasalazine-induced extrinsic allergic alveolitis in a patient with psoriatic arthritis ' (2001 ) 6 Eur. J. Med. Res. : 495 -497.

    • Search Google Scholar
  • Nakano, K., Gemma, H., Ono, T. és mtsai: A case of minocycline-induced eosinophilic pneumonia presenting with multiple white eosinophilic plaques in the tracheobronchial mucosa. Nihon Kokyuki Gakkai Zasshi, 2001, 39 , 24–29.

    Ono T. , 'A case of minocycline-induced eosinophilic pneumonia presenting with multiple white eosinophilic plaques in the tracheobronchial mucosa ' (2001 ) 39 Nihon Kokyuki Gakkai Zasshi : 24 -29.

    • Search Google Scholar
  • Castell, J. V., Castell, M.: Allergic hepatitis induced by drugs. Curr. Opin. Allergy Clin. Immunol., 2006, 6 , 258–265.

    Castell M. , 'Allergic hepatitis induced by drugs ' (2006 ) 6 Curr. Opin. Allergy Clin. Immunol. : 258 -265.

    • Search Google Scholar
  • Cher, D. J., Deubner, D. C., Kelsh, M. A. és mtsai: Assessment of the beryllium lymphocyte proliferation test using statistical process control. Inhal. Toxicol., 2006, 18 , 901–910.

    Kelsh M. A. , 'Assessment of the beryllium lymphocyte proliferation test using statistical process control ' (2006 ) 18 Inhal. Toxicol. : 901 -910.

    • Search Google Scholar
  • von Baehr, V., Hermes, A., von Baehr, R. és mtsai: Allergoid-specific T-cell reaction as a measure of the immunological response to specific immunotherapy (SIT) with a Th1-adjuvanted allergy vaccine. J. Investig. Allergol. Clin. Immunol., 2005, 15 , 234–241.

    Baehr R. , 'Allergoid-specific T-cell reaction as a measure of the immunological response to specific immunotherapy (SIT) with a Th1-adjuvanted allergy vaccine ' (2005 ) 15 J. Investig. Allergol. Clin. Immunol. : 234 -241.

    • Search Google Scholar
  • Valentine-Thon, E., Ilsemann, K., Sandkamp, M.: A novel lymphocyte transformation test (LTT-MELISA(R)) for Lyme borreliosis. Diagn. Microbiol. Infect. Dis., 2007, 57 , 27–34.

    Sandkamp M. , 'A novel lymphocyte transformation test (LTT-MELISA(R)) for Lyme borreliosis ' (2007 ) 57 Diagn. Microbiol. Infect. Dis. : 27 -34.

    • Search Google Scholar
  • Matsui, S., Yamashita, N., Maruyama, M. és mtsai: Acute eosinophilic pneumonia induced by cigarette smoking: positive lymphocyte stimulation test of a cigarette extract. Nihon Kokyuki Gakkai Zasshi, 2000, 38 , 807–811.

    Maruyama M. , 'Acute eosinophilic pneumonia induced by cigarette smoking: positive lymphocyte stimulation test of a cigarette extract ' (2000 ) 38 Nihon Kokyuki Gakkai Zasshi : 807 -811.

    • Search Google Scholar