A novel system to diagnose cutaneous adverse drug reactions employing the cellscan--comparison with histamine releasing test and Inf-gamma Releasing Test.
BACKGROUND
There are several mechanisms to describe allergic drug reactions yet the methods to diagnose them are limited.


OBJECTIVE
To compare several conventional clinical and laboratory methods to diagnose skin reactions to drugs to a new method of diagnosing drug reactions by the CellScan system.


METHODS
The study entailed 21 patients who were diagnosed as suffering from drug eruptions, and 105 healthy controls with no history of drug allergy. The drugs were classified into two groups according to suspicion of causing drug allergy: high and low. Most of the patients were on more than one drug, leading to 41 patient-drug interactions (assays). Histamine releasing test (HRT), interferon (INF)-gamma releasing test and CellScan examination were performed on lymphocytes of the patients and controls.


RESULTS
The HRTwas interpreted as positive in 9 out of 18 (50%) patients and in 13 out of 35 (37%) assays. Based on the INF-gamma releasing test, positive results were observed in 16 out of 21 (76%) patients and in 24 out of 41 (59%) assays. In the CellScan test (CST), positive results were observed in 17 out of 21 (81%) patients and in 29 out of 41 (71%) assays. The rate of identifying the drug for eruption in the high suspicion level drugs was 9 out of 22 (41%) assays in the HRT, 20 out of 24 (83%) assays in the INF-gamma releasing test, and 21 out of 24 (87%) studies with the CellScan method. The rate of determining of the drug that caused the eruption in the low suspicion level drugs was 4 out of 13 (31 %) in the HRT, 4 out of 17 (24%) assays in the INF-gamma releasing test, and 8 out of 17 (47%) analyses in the CST. When examined in the CellScan, 99 out of 105 (94%) controls were interpreted as negative.


CONCLUSIONS
This preliminary study indicates that the CellScan seems to be an easy and promising method for the detection of drugs responsible for adverse skin reactions. In contrast to the HRT and to the Interferon-gamma secretion test, the CellScan method is characterized by its ability to track and monitor the reaction of individual cells. By measuring the kinetic parameters of selected cells before and after adding the suspected drug, we were able to identify the culprit drug. The CellScan method had the highest sensitivity, and the interferon-gamma secretion test had the highest specificity for detection of the culprit drug. In contrast, the analysis of 105 normal control sera disclosed a high specificity of 94% for the CellScan method.
Goldberg
Ilan
I
Department of Dermatology, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel. shoenfel@post.tau.ac.il
Gilburd
Boris
B
Kravitz
Martine Szyper
MS
Kivity
Shmuel
S
Chaim
Berta Ben
BB
Klein
Tirza
T
Schiffenbauer
Yael
Y
Trubniykovr
Ela
E
Brenner
Sarah
S
Shoenfeld
Yehuda
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003955:Diagnostic Tests, Routine / Q000379:methods*; D003875:Drug Eruptions / Q000175:diagnosis / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006636:Histamine Release / Q000276:immunology*; D006801:Humans; D007371:Interferon-gamma / Q000276:immunology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000175:diagnosis* / Q000276:immunology
D007371:Interferon-gamma