Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches.
Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated. DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions. One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic.
Division of Medicine for Allergic Disease, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan. matsunoo@ra.opho.jp
Osamu
O
Matsuno
D000818:Animals; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000175:diagnosis* / Q000276:immunology