Delayed Allergic Reaction to Suxamethonium Driven by Oligoclonal Th1-Skewed CD4+CCR4+IFN-γ+ Memory T Cells

Abstract

Background: Muscle relaxants represent the drugs most frequently involved in intraoperative anaphylaxis during surgical procedures. Our aim was to report the case of a delayed reaction to suxamethonium and analyze specific T cell lines with regard to their specificity, phenotype and cytokine profile. Methods: We generated a drug-specific T cell line from a biopsy at the site of positive intradermal reactions and analyzed the immunophenotype, T cell receptor Vβ domain expression and cytokine profile. Results: T cells isolated from positive intradermal test reactions to suxamethonium showed a strict dose-dependent proliferation in response to drug-pulsed autologous antigen-presenting cells. The drug-specific CD4+ T cells were oligoclonal memory CD3+CD4+ T cells and expressed the skin homing receptors cutaneous lymphocyte antigen (CLA) and CCR4. Furthermore CD4+ suxamethonium-reactive T cell lines were IFN-γ-positive and synthesized high levels of IFN-γ and TNF-α. Conclusion: The study describes a delayed hypersensitivity to suxamethonium, driven by an oligoclonal T helper cell 1-skewed CD4+ memory T cell population, expressing the skin homing receptors CLA and CCR4.

Muscle Relaxants Allergy

“…T cell mediated immune responses play an important role in both immediate and delayed types of adverse drug reactions. Recently, a delayed hypersensitivity to suxamethonium, driven by an oligoclonal T helper cell 1-skewed CD4+ memory T cell population, expressing the skin homing receptors CLA (cutaneous lymphocyte antigen) and CCR4 has been described (19).…”