A Case of Pulmonary Reaction with Skin Eruption Showing a Positive Peripheral Lymphocyte Stimulation Test Result for Ethambutol

Hiraoka, Katsumi; Nagata, Nobuhiko; Suzuki, Kazumasa; Kawajiri, Tatsunori; Kurokawa, Susumu; Kawamura, Takahiko; Kido, Masamitsu

doi:10.7888/juoeh.20.145

Cited by 2 publications

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“…9,12,43) In the present study, the LMT showed a positive rate twice as high as that of the DLST for skin eruptions, and 4 times higher for liver damage. In addition, the LMT showed higher positive rates than the DLST for many other hypersensitivity symptoms.…”

Section: Positive Rates Of the Dlst And Lmt According Tosupporting

confidence: 48%

Comparative Study of the Usefulness of the Drug-Induced Lymphocyte Stimulation Test and the Leukocyte Migration Test in Drug Allergies

Saito¹,

Yagi²,

Uno

et al. 2008

Biological & Pharmaceutical Bulletin

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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...

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Section: Positive Rates Of the Dlst And Lmt According Tosupporting

confidence: 48%

Comparative Study of the Usefulness of the Drug-Induced Lymphocyte Stimulation Test and the Leukocyte Migration Test in Drug Allergies

Saito¹,

Yagi²,

Uno

et al. 2008

Biological & Pharmaceutical Bulletin

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“…Reactions as rash and drug fever have been reported in 0.5% and 0.3% of patients, respectively [6], and other hypersensitivity reactions, as ashy dermatosis-like pigmentation [7], lichenoid eruptions [8], pulmonary infiltrates [9], and toxic epidermal necrolysis [10], have been described. Ethambutol is usually used in combined therapy with other antibiotics, which makes diagnosis particularly difficult.…”

Section: Commentsmentioning

confidence: 99%

“…The recommended approach in generalized cutaneous reactions is stopping all combined treatment and gradually reintroducing each of the antimycobacterial drugs, to determine the offending drug [11]. Skin and serological tests are usually unreliable, with one paper presenting a positive epicutaneous test [12] and another positive lymphocyte stimulation test [9] to ethambutol.…”

Section: Commentsmentioning

confidence: 99%

Hypersensitivity Reaction and Tolerance Induction to Ethambutol

Cernadas

Santos

Pinto

et al. 2013

Case Reports in Medicine

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Tuberculosis remains the leading cause of death worldwide from any infectious agent and the alarming increase in the annual incidence of new cases has been described as a global emergency. Mycobacterium infection requires simultaneous administration of multiple drugs. Although the majority of treatment courses progress with minor side effects, adverse reactions to antituberculosis drugs occur in about 5% of treated patients and can be responsible for cessation or switching the therapy. Both nonimmediate (mostly maculopapular rash) and immediate reactions (urticarial reactions) have been described with these drugs. The main problem is the occurrence of reactions while the patient is on treatment with multiple drugs. The diagnosis of the culprit drug is mostly based on stopping all medication, followed by the reintroduction of each drug with a time interval of four to five days. An alternative drug should be the first approach if it is equally effective. Most of the times, none of the alternative drugs are as effective as the culprit. If this is the case, a desensitization procedure should be performed. The authors describe a case of a woman with Mycobacterium avium complex (MAC) infection, to whom treatment with ethambutol was crucial to recovery, and present a modified desensitization protocol to this drug.

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A Case of Pulmonary Reaction with Skin Eruption Showing a Positive Peripheral Lymphocyte Stimulation Test Result for Ethambutol

Cited by 2 publications

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Comparative Study of the Usefulness of the Drug-Induced Lymphocyte Stimulation Test and the Leukocyte Migration Test in Drug Allergies

Comparative Study of the Usefulness of the Drug-Induced Lymphocyte Stimulation Test and the Leukocyte Migration Test in Drug Allergies

Hypersensitivity Reaction and Tolerance Induction to Ethambutol

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