Delayed allergic reaction to suxamethonium driven by oligoclonal Th1-skewed CD4+CCR4+IFN-gamma+ memory T cells.
BACKGROUND
Muscle relaxants represent the drugs most frequently involved in intraoperative anaphylaxis during surgical procedures. Our aim was to report the case of a delayed reaction to suxamethonium and analyze specific T cell lines with regard to their specificity, phenotype and cytokine profile.


METHODS
We generated a drug-specific T cell line from a biopsy at the site of positive intradermal reactions and analyzed the immunophenotype, T cell receptor Vbeta domain expression and cytokine profile.


RESULTS
T cells isolated from positive intradermal test reactions to suxamethonium showed a strict dose-dependent proliferation in response to drug-pulsed autologous antigen-presenting cells. The drug-specific CD4+ T cells were oligoclonal memory CD3+CD4+ T cells and expressed the skin homing receptors cutaneous lymphocyte antigen (CLA) and CCR4. Furthermore CD4+ suxamethonium-reactive T cell lines were IFN-gamma-positive and synthesized high levels of IFN-gamma and TNF-alpha.


CONCLUSIONS
The study describes a delayed hypersensitivity to suxamethonium, driven by an oligoclonal T helper cell 1-skewed CD4+ memory T cell population, expressing the skin homing receptors CLA and CCR4.
Scala
Enrico
E
Istituto Dermopatico dell'Immacolata - IDI, Experimental Allergology Unit, Rome, Italy. e.scala@idi.it
Guerra
Emma C
EC
Giani
Mauro
M
Pirrotta
Lia
L
Locanto
Maria
M
Mondino
Chiara
C
Mari
Adriano
A
D000759:Adjuvants, Anesthesia / Q000276:immunology; D000368:Aged; D018686:Anesthetics, Intravenous / Q000276:immunology; D001285:Atropine / Q000276:immunology; D015704:CD4 Antigens / Q000276:immunology; D002999:Clone Cells; D004342:Drug Hypersensitivity / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced*; D007044:Hysterectomy / Q000009:adverse effects; D007156:Immunologic Memory / Q000276:immunology; D016130:Immunophenotyping; D007371:Interferon-gamma / Q000276:immunology; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects* / Q000276:immunology; D011183:Postoperative Complications / Q000276:immunology*; D015742:Propofol / Q000276:immunology; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000276:immunology; D054398:Receptors, CCR4; D019707:Receptors, Chemokine / Q000276:immunology; D012871:Skin Diseases / Q000139:chemically induced / Q000276:immunology; D013390:Succinylcholine / Q000009:adverse effects* / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology*
D000759:Adjuvants, Anesthesia; D018686:Anesthetics, Intravenous; C515354:CCR4 protein, human; D015704:CD4 Antigens; D009467:Neuromuscular Depolarizing Agents; D016693:Receptors, Antigen, T-Cell, alpha-beta; D054398:Receptors, CCR4; D019707:Receptors, Chemokine; D001285:Atropine; D007371:Interferon-gamma; D013390:Succinylcholine; D015742:Propofol