Multiple drug allergy in patients with cutaneous adverse drug reactions diagnosed by in vitro drug-induced interferon-gamma release.
BACKGROUND
Multiple drug allergy syndrome is a rarely reported clinical condition characterized by an adverse reaction to more than one different class of pharmacologically and structurally unrelated drugs. The pathogenesis may involve immediate-type or delayed-type hypersensitivity.


OBJECTIVE
To further characterize patients with MDA in terms of the type of CADR, drug intake and clinical drug suspicion.


METHODS
The study group comprised 12 patients (6 males, 6 females) with CADRs showing in vitro drug-induced IFNgamma release for multiple drugs, suggesting the presence of MDA. The diagnostic role of in vitro IFNgamma release in identifying the culprit drugs was evaluated in terms of clinical data and the results of in vivo tests (withdrawal and/or challenge tests) with the offending drugs.


RESULTS
Clinical relevance was attributed to in vitro drug-induced IFNgamma release towards multiple drugs in this series of 12 patients with a variety of CADRs, implying MDA. The results of in vivo tests for the offending drugs confirmed the diagnosis. The main causative agents responsible were antibiotics and non-steroidal anti-inflammatory drugs.


CONCLUSIONS
The study further supports the role of a T cell-mediated mechanism in the pathogenesis of MDA. The in vitro drug-induced IFNgamma release test may serve as a laboratory tool to identify the culprit drugs associated with this allergy.
Halevy
Sima
S
Department of Dermatology, Soroka University Medical Center, Beer Sheva, Israel. halevy@bgu.ac.il
Grossman
Nili
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002675:Child, Preschool; D003875:Drug Eruptions / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007371:Interferon-gamma