title: Identification of thymus and activation-regulated chemokine (TARC/CCL17) as a potential marker for early indication of disease and prediction of disease activity in drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS).
abstract: BACKGROUND
  Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a serious acute drug reaction with fever, cutaneous eruption, lymphadenopathy, and several visceral dysfunctions. Eosinophilia is a common hematological abnormality in DIHS/DRESS suggesting that the Th2-type immune response is involved. Thymus and activation-regulated chemokine (TARC/CCL17) is a family of CC chemokines known to play an important role in Th2-mediated immune-inflammatory processes.
  
  
  OBJECTIVE
  We investigated the pathogenic role of TARC in patients with DIHS.
  
  
  METHODS
  Sera were obtained from 8 patients with DIHS, 7 patients with Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN), and 14 patients with drug-induced maculopapular exanthema (MPE). Serum TARC levels were measured by ELISA. TARC levels were then compared with clinical symptoms and various hematological parameters. In addition, a biopsy was taken from the lesional skin of patients with DIHS and stained with anti-TARC Ab and anti-CD11c Ab.
  
  
  RESULTS
  Serum TARC levels in patients with DIHS were significantly higher than those in patients with SJS/TEN and MPE during the acute phase. Serum TARC levels in DIHS patients correlated with skin eruptions, serum sIL-2R levels, eosinophil counts, and serum IL-5 levels. Immunohistochemical staining revealed that TARC was mainly expressed on CD11c+ dermal dendritic cells in patients with DIHS.
  
  
  CONCLUSIONS
  Serum TARC levels may be associated with the initial presentation of DIHS as well as disease activity during the course. Thus, they could be useful as an indicator for early diagnosis and assessment of disease activity in DIHS. CD11c+ dendritic cells may be the main source of TARC in patients with DIHS.
authors.affiliation: Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Hironori
authors.initials: H
authors.lastname: Morito
authors.forename: Ayako
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Natsuko
authors.initials: N
authors.lastname: Daikoku
authors.forename: Fumi
authors.initials: F
authors.lastname: Miyagawa
authors.forename: Aiko
authors.initials: A
authors.lastname: Okazaki
authors.forename: Takaya
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kasai
authors.forename: Hideaki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sueki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Iijima
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tohyama
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Asada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054414:Chemokine CCL17 / Q000097:blood*; D003713:Dendritic Cells / Q000378:metabolism; D003875:Drug Eruptions / Q000097:blood* / Q000175:diagnosis*; D004802:Eosinophilia / Q000097:blood* / Q000139:chemically induced; D004804:Eosinophils; D005076:Exanthema / Q000097:blood / Q000139:chemically induced; D005260:Female; D006801:Humans; D015848:Interleukin-5 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015375:Receptors, Interleukin-2 / Q000097:blood; D013262:Stevens-Johnson Syndrome / Q000097:blood / Q000139:chemically induced; D055815:Young Adult
chemical_list: D054414:Chemokine CCL17; D015848:Interleukin-5; D015375:Receptors, Interleukin-2