title: Distinct delayed T-cell response to beta-methasone and penicillin-G in the same patient.
abstract: BACKGROUND
  Multiple drug allergy syndrome is a clinical condition characterized by reactions against more than one different class of, both pharmacologically and structurally, unrelated drugs. Scanty data are available to date about a multiple drug delayed hypersensitivity syndrome. Our aim was to report the case of a delayed reaction to both beta-methasone (beta-MT) and penicillin-G (pen-G) occurring in the same patient, and analyse beta-MT- and pen-G-specific T-cell Lines (TCLs) with regard to their specificity, phenotype and cytokine profile.
  
  
  METHODS
  We generated two drug-specific TCLs from biopsies at the site of positive intradermal reactions, and analysed their immunophenotype, T-cell receptor Vbeta (TCR-Vbeta) domains expression and cytokine profile.
  
  
  RESULTS
  We demonstrated the specificity of the T cells isolated from positive intradermal test reactions to pen-G and beta-MT through the strict dose-dependent proliferation in response to drug-pulsed autologous antigen presenting cells. Fluorescence activated cell sorter (FACS) analysis revealed a predominance of CD4+ cells in the inflammatory cell infiltrate of intradermal test with beta-MT, while a predominance of CD8+ T cells in the site of delayed reaction to pen-G was found. The drug specific CD4+ and CD8+ T cells were heterogeneous, with regard to TCR-Vbeta usage. CD8+ pen-G-TCL displayed a preferential T helper 2 (Th2) profile, while a substantially heterogeneous pattern of cytokine production characterized specific beta-MT TCL.
  
  
  CONCLUSIONS
  The study describes the coexistence in the same patient of a delayed hypersensitivity to both penicillin G and beta-MT, driven, respectively, by pen-G-specificTh2-skewed CD8+ and beta-MT specificTh0 CD4+ T cells. This case further support the existence of a multiple drug allergy syndrome also for delayed hypersensitivity.
authors.affiliation: Istituto Dermopatico dell'Immacolata - IDI, IRCCS, Department of Onco-Immuno-Dermatology, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Scala
authors.forename: M
authors.initials: M
authors.lastname: Giani
authors.forename: S
authors.initials: S
authors.lastname: Pastore
authors.forename: S
authors.initials: S
authors.lastname: Pallotta
authors.forename: E C
authors.initials: EC
authors.lastname: Guerra
authors.forename: L
authors.initials: L
authors.lastname: Pirrotta
authors.forename: M L
authors.initials: ML
authors.lastname: Locanto
authors.forename: A
authors.initials: A
authors.lastname: Frezzolini
authors.forename: O
authors.initials: O
authors.lastname: De Pità
authors.forename: P
authors.initials: P
authors.lastname: Puddu
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000009:adverse effects* / Q000276:immunology; D002469:Cell Separation; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005434:Flow Cytometry; D005938:Glucocorticoids / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis*; D015848:Interleukin-5 / Q000096:biosynthesis; D008297:Male; D010400:Penicillin G / Q000009:adverse effects* / Q000276:immunology; D010406:Penicillins / Q000009:adverse effects* / Q000276:immunology; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000276:immunology*; D012882:Skin Tests; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D005938:Glucocorticoids; D015848:Interleukin-5; D010406:Penicillins; D016693:Receptors, Antigen, T-Cell, alpha-beta; D001623:Betamethasone; D010400:Penicillin G