title: Delayed allergic reaction to suxamethonium driven by oligoclonal Th1-skewed CD4+CCR4+IFN-gamma+ memory T cells.
abstract: 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.
authors.affiliation: Istituto Dermopatico dell'Immacolata - IDI, Experimental Allergology Unit, Rome, Italy. e.scala@idi.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Scala
authors.forename: Emma C
authors.initials: EC
authors.lastname: Guerra
authors.forename: Mauro
authors.initials: M
authors.lastname: Giani
authors.forename: Lia
authors.initials: L
authors.lastname: Pirrotta
authors.forename: Maria
authors.initials: M
authors.lastname: Locanto
authors.forename: Chiara
authors.initials: C
authors.lastname: Mondino
authors.forename: Adriano
authors.initials: A
authors.lastname: Mari
mesh_terms: 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*
chemical_list: 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