The detection of the causative drug in drug allergies is essential in order to prevent secondary allergic reactions and is also extremely important so that appropriate medical treatment can be administered when such reactions occur. However, in vivo tests are problematic in that challenge tests are too risky, the intradermal skin test is a low-sensitivity test that has few risks but may cause penicillin-induced anaphylactic shock, 1) and the patch test is also a low-sensitivity test but may induce contact dermatitis.2) Therefore, more effective in vitro tests, which pose few risks to patients, are needed.In vitro, specific antibodies for the allergens in patient's serum can be detected by enzyme-linked immunosorbent assay (ELISA) or the radioallergosorbent test (RAST). The specific immunoglobulin E (IgE), IgG, and IgM antibodies are measured by ELISA and specific IgE antibodies are identified by the RAST. The advantages of these methods detecting specific antibodies are that their test samples, i.e., the patient's serum can be preserved for a long time. On the other hand, their disadvantages are that they show a low rate of detection and are applied to only a part of causative drugs such as penicillin antibiotics and only specific allergic symptoms such as anaphylactic shock and hemolytic anemia.3,4) Furthermore, they must be performed as soon as the allergic symptoms develop because the specific antibodies disappear in about a month.There has been a recent increase in the use of methods to prove cell-mediated immunity, that is, the presence of drugsensitized lymphocytes. Such methods include the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT).3,5-11) The advantages of these methods detecting drug-sensitized lymphocytes are that they show a higher rate of detection than the methods detecting specific antibodies and can be applied to many causative drugs and allergic symptoms.3,4) On the other hand, their disadvantages are that their test samples, i.e., the patient's mononuclear cells can't be preserved for a long time. Therefore, the methods detecting drug-sensitized lymphocytes may be more useful to detect the causative drugs in many drug allergies than the methods detecting specific antibodies if their tests are putted into practice soon after drawing bloods. However, there have been few reports to date comparing the effectiveness of these tests. Therefore, we performed both the DLST and LMT in patients suspected of drug hypersensitivity as well as in patients without drug hypersensitivity and compared the usefulness of the two tests. MATERIALS AND METHODS Subjects (Patients Suspected of Drug-Induced Hypersensitivity)The subjects consisted of 133 patients (60 males and 73 females; age range 1-84 years; mean age 47.8 years) who were suspected of suffering from drug-induced hypersensitivity. These patients had manifested hypersensitivity symptoms while taking drugs and were unlikely to suffer worsening of the underlying disease, and their symptoms improved when they stopped...

No abstract

Increased CXCL8 levels produced by beta-lactams administration were accompanied by LMIA. CXCL8 may be involved in LMIA and play a role in beta-lactam allergies. In contrast, the LMIA detected in patients with allergies to APAs may be a cytokine or chemokine other than CXCL8.

There is a high possibility that these adverse reactions were caused by pseudoallergy to drug. Even by allergic reactions, it was assumed that 80% of them might be caused by antiseptic agents such as paraben. In addition, it was suggested that ALAs, especially lidocaine hydrochloride preparations have high antigenicity (sensitizing property). Furthermore, it was considered that patients with past history of drug or food allergies have a high potential for manifestation of the reactions.

In vivo tests may be used for the diagnosis of allergy to iodinated contrast media (ICM); however, the tests do not provide definitive diagnosis and are associated with risks for patients. Diagnoses based on in vitro tests are limited, and there are almost no relevant studies. Herein, the authors examined involvement of allergic reaction from a multilateral standpoint in 39 patients suspected of having ICM allergies using leukocyte migration test (LMT). The positive rate of LMT was 44%. A comparison with the positive rate of LMT in drugs other than ICM (74%) indicated 30% difference, which was significantly low value, suggesting that there is poor involvement of these drugs in the allergic reaction. In LMT positives, 76% of hypersensitivity reactions were skin rash mainly erythema, and 18% was anaphylactic reactions. Cases considered as non-immediate hypersensitivity accounted for about 4 times as many as immediate-type hypersensitivity. In examination of relevancy between a history of drugs or food allergies, the incidence of ICM allergies was 35%. There is a high possibility that these adverse reactions were caused by pseudoallergy to drug. It was suggested that most hypersensitivity reactions were skin rash related to non-immediate hypersensitivity, and approximately 20% of the reaction was immediate anaphylactic reaction. Therefore attention should be paid not only to immediate-type hypersensitivity but also delayed reactions. Moreover, it was considered that patients with past history of drug or food allergies have a high potential for manifestation of the reactions.Key words iodinated contrast media (ICM); leukocyte migration test (LMT); pseudoallergy; non-immediate hypersensitivity; allergic history Since the late 1980 s, a number of hypoosmotic, nonionic iodinated contrast media (ICM) have been used instead of ionic ICM. To meet this trend, development of serious adverse effects, such as pain, sensations of burning and anaphylactoid symptoms at the time of high-pressure injection, reduced significantly. On the other hand, allergic side effects caused by nonionic ICM became to attract attention, and not only immediate type hypersensitivity cases, which have a high severity, but also delayed hypersensitivity cases have been reported. [1][2][3][4][5] However, test methods used when ICM allergy is suspected are in vivo identification tests including patch test, intracutaneous reaction test, prick test and scratch test. As in vitro identification tests, radio-allergo-solvent test (RAST) using specific immunoglobulin E (IgE) antibody, histamine release test (HRT), basophil activation test (BAT) and drug-induced lymphocyte stimulation test (DLST) may be conducted. DLST are often used in clinical practice; however, clinical utility in the diagnosis of ICM allergy is not proved yet because of its low detection sensitivity. In other words, there is almost no research analysis that used in vitro identification methods for multiple cases to identify ICM allergy, and proved its utility.Authors have reported that leuk...