Distinct serum cytokine levels in drug- and measles-induced exanthema.
BACKGROUND
Macular or maculopapular skin reactions are frequent events in drug allergy as well as in viral infections. Clinically, the differentiation may be difficult in the absence of a clear relationship to drug intake or failure to detect virus-specific antibodies of the IgM class. Studies on drug-specific T cell lines and T cell clones isolated from drug-allergic patients have suggested that these cells may represent a significant source of IL-5. On the other hand, viral infections are frequently associated with elevated IFN-gamma levels.


OBJECTIVE
Determination of serum-cytokine levels to differentiate between drug- and virally induced skin eruptions.


METHODS
18 patients suffering from acute drug allergy and 19 patients with acute measles, rubella or parvovirus infection.


METHODS
Cytokine-ELISA (IL-5, IL-4 and IFN-gamma) of sera collected during acute drug allergy or during acute measles, rubella or parvovirus infection.


RESULTS
In 12/18 patients with drug allergy, IL-5 and/or IL-4 were elevated. A significant correlation (r(Spearman) = 0.84) between IL-5 serum levels and eosinophil counts in the blood was found. No correlation was detected between IL-4 and blood eosinophilia or between IL-4 and IL-5 levels. After remission, IL-5 and IL-4 decreased to undetectable levels. IFN-gamma on the other hand was not measurable in patients with drug allergy while elevated IFN-gamma serum levels were detected in 17/19 patients with measles, rubella or parvovirus infection; 2 patients with acute virus infection had elevated IL-5, and/or IL-4 and IFN-gamma levels.


CONCLUSIONS
These data underline the distinct pathogenesis of these morphologically similar exanthemas and suggest that the combined analysis of eosinophilia in the blood, IL-4 and IFN-gamma might help in differentiating skin eruptions.
Hari
Y
Y
Institute of Immunology and Allergology, University of Bern, Bern, Switzerland.
Urwyler
A
A
Hurni
M
M
Yawalkar
N
N
Dahinden
C
C
Wendland
T
T
Braathen
L R
LR
Matter
L
L
Pichler
W J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016207:Cytokines / Q000097:blood*; D004342:Drug Hypersensitivity / Q000097:blood* / Q000150:complications; D004802:Eosinophilia / Q000150:complications / Q000378:metabolism; D005076:Exanthema / Q000097:blood* / Q000139:chemically induced / Q000821:virology; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D015848:Interleukin-5 / Q000097:blood; D008297:Male; D008457:Measles / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000150:complications / Q000378:metabolism; D011446:Prospective Studies; D012409:Rubella / Q000097:blood* / Q000150:complications / Q000378:metabolism
D016207:Cytokines; D015848:Interleukin-5; D015847:Interleukin-4; D007371:Interferon-gamma