Multiple drug hypersensivity: insight into the underlying mechanism and correlation with autoimmune diseases.
BACKGROUND
Subjects with drug hypersensitivity are sometimes simultaneously reactive to several drugs. This nosological entity is defined as multiple drug hypersensivity (MDH). Urticaria and angioedema are the commonest clinical manifestations of hypersensitivity drug reactions (HDR). These clinical signs are also pathognomonic of chronic idiopathic urticaria (CIU), whose pathogenetic mechanisms are still largely unknown. The diagnostic algorithm of CIU includes autologous serum skin test (ASST) and autologous plasma skin test (APST), which demonstrated a high positive and negative predictive value, in multiple nonsteroidal anti-inflammatory drugs (NSAIDs) intolerance.


OBJECTIVE
to explore the underlying mechanism of MDH and to assess the correlation between such tests and autoimmune diseases (AD).


METHODS
Twenty eight subjects with MDH referred to our Allergy/Immunology Unit were enrolled from May 2006 to May 2007. Eight healthy subjects served as controls. In addition to common diagnostic tools used in the diagnostic algorithm of MDH, enrolled subjects also underwent ASST and APST.


RESULTS
Patients were predominantly female (23 female vs. 5 male; mean age 52.2 years). In 61% of cases MDH was associated with either CIU or AD. NSAIDs and antibiotics were the major causes of HIDR, both implied in 54% of subjects. The proportions of MDH-subjects with positive ASST and APST were 46.4% and 28.6%, respectively. All patients with MDH+AD+CIU (4/4) presented apositive ASST.


CONCLUSIONS
In patients with MDH, ASST proved to be frequently positive, as previously described for multiple NSAIDs intolerance. In ASST-positive subjects, the activity of several drugs appears to add up FceRI-specific autoantibodies in the induction of the release of allergic mediators.
Colombo
G
G
Allergy and Immunology Department, IRCCS San Raffaele Hospital, Milan, Italy.
Yacoub
M R
MR
Burastero
S E
SE
Garattini
E
E
Girlanda
S
S
Saporiti
N
N
Salvo
F
F
Sabbadini
M G
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D002908:Chronic Disease / Q000453:epidemiology; D004342:Drug Hypersensitivity / Q000150:complications* / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D005260:Female; D050031:Hashimoto Disease / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017455:Receptors, IgE / Q000276:immunology; D044967:Serum / Q000276:immunology; D012882:Skin Tests; D014581:Urticaria / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001323:Autoantibodies; D017455:Receptors, IgE