interleukin-8 and Drug-Hypersensitivity

The purpose of the present review is to update knowledge on acute generalized exanthematous pustulosis (AGEP) in terms of epidemiology, pathogenesis, cause, clinical features, diagnosis, and treatment.. AGEP is a rare reaction pattern attributed mainly to drugs. Drug-specific T cells (CD4+ and CD8+) and the production of interleukin-8/CXCL8 play an important role in its pathogenesis. A large-scale case-control study (EuroSCAR study) revealed a broad spectrum of drugs strongly associated with AGEP characterized by different time patterns (latent periods). Recent publications have supported the recognized role of individual drugs in the induction of AGEP and some have reported newly incriminated drugs. Many recent publications on AGEP have used the AGEP validation score (EuroSCAR group criteria) to establish the diagnosis. The value of in-vivo tests (mainly patch tests), in-vitro tests (the lymphocyte transformation test and cytokine release tests), or both for the identification of causative drugs has been demonstrated. Infections do not play a prominent role in the development of AGEP. There is no evidence for the assumption that AGEP is a variant of pustular psoriasis. Unique observations related to AGEP include a marked female predominance, a possible role for seasonality and a causal role for spider bites.. A broad spectrum of drugs is associated with AGEP, a T cell-mediated reaction. Genetic susceptibility and the possible role of other risk factors in AGEP should be further evaluated in larger studies of AGEP patients with a validated diagnosis.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Drug Hypersensitivity; Exanthema; Female; Humans; Interleukin-8; Lymphocyte Activation; Patch Tests; Psoriasis; Sex Factors; Spider Bites; Spiders

The Jarisch-Herxheimer reaction (JHR) observed after antibiotic treatment of relapsing fever caused by Borrelia recurrentis is associated with the systemic appearance of cytokines. The decrease of cytokine production and block of JHR was attempted by administering pentoxifylline prior to antibiotic treatment. Fifteen patients with confirmed relapsing fever were infused intravenously with pentoxifylline 90 min before intramuscular injection of penicillin; 4 patients were not treated with pentoxifylline. All patients developed JHR to varying degrees. Treatment with pentoxifylline failed to prevent fever, increase in pulse, respiration, or blood pressure, or decrease in white blood cell count. No reduction of circulating levels of tumor necrosis factor, interleukin 6, or interleukin-8 was observed with pentoxifylline treatment. Pentoxifylline did not prevent clearance of the B. recurrentis spirochetes. Thus, pentoxifylline treatment of patients with relapsing fever fails to prevent or diminish JHR or the associated cytokine release observed after appropriate antibiotic treatment.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cytokines; Drug Hypersensitivity; Female; Humans; Interleukin-6; Interleukin-8; Male; Middle Aged; Penicillins; Pentoxifylline; Relapsing Fever; Tumor Necrosis Factor-alpha; Vasodilator Agents

Hypersensitivity drug reactions (HDRs) are common among drugs, despite this, there are no validated in vitro or in vivo methods for screening the sensitizing potential of drugs in the preclinical phase. We previously developed the THP-1 activation assay, based on CD86 upregulation and IL-8 production, for the in vitro identification of drugs able to induce selective dendritic cell activation. In this paper, we investigated the predictive capacity of the method toward drugs associated with HDRs for which a correlation with specific human leukocyte antigens (HLA) have been demonstrated. For that purpose, abacavir, carbamazepine and clozapine were used. Metformin was used as negative control. Dose- and time-course experiments were conducted. The surface markers CD86, CD54 and HLA-DR were evaluated by flow cytometry analysis, whereas IL-8 release by ELISA. Abacavir, carbamazepine and clozapine gave positive results with CD86 upregulation and/or IL-8 release, with abacavir also inducing HLA-DR. The test reveals the ability of drugs to induce dendritic cell activation (signals 1/2), that preceded the adaptive immune response, which will be manifested only in a minority of patients carrying the specific HLA genotypes. The idea is to integrate this simple method during drug development to identify the potential of drugs to induce hypersensitivity reactions in the pre-clinical phase.

Topics: B7-2 Antigen; Carbamazepine; Cell Survival; Clozapine; Dideoxynucleosides; Drug Hypersensitivity; Genotype; HLA Antigens; Humans; Intercellular Adhesion Molecule-1; Interleukin-8; Metformin; THP-1 Cells

Despite important impacts of systemic hypersensitivity induced by pharmaceuticals, for such endpoint no reliable preclinical approaches are available. We previously established an in vitro test to identify contact and respiratory allergens based on interleukin-8 (IL-8) production in THP-1 cells. Here, we challenged it for identification of pharmaceuticals associated with systemic hypersensitivity reactions, with the idea that drug sensitizers share common mechanisms of cell activation. Cells were exposed to drugs associated with systemic hypersensitivity reactions (streptozotocin, sulfamethoxazole, neomycin, probenecid, clonidine, procainamide, ofloxacin, methyl salicylate), while metformin was used as negative drug. Differently to chemicals, drugs tested were well tolerated, except clonidine and probenecid, with no signs of cytotoxicity up to 1-2mg/ml. THP-1 activation assay was adjusted, and conditions, that allow identification of all sensitizing drugs tested, were established. Next, using streptozotocin and selective inhibitors of PKC-β and p38 MAPK, two pathways involved in chemical allergen-induced cell activation, we tested the hypothesis that similar pathways were also involved in drug-induced IL-8 production and CD86 upregulation. Results indicated that drugs and chemical allergens share similar activation pathways. Finally, we made a structure-activity hypothesis related to hypersensitivity reactions, trying to individuate structural requisite that can be involved in immune mediated adverse reactions.

Topics: Allergens; B7-2 Antigen; Biological Assay; Cell Line; Cell Survival; Drug Evaluation, Preclinical; Drug Hypersensitivity; Humans; Intercellular Adhesion Molecule-1; Interleukin-8; p38 Mitogen-Activated Protein Kinases; Protein Kinase C beta

Perfluorooctanoic acid (PFOA) has unique physical and chemical characteristics, water and oil repellency, thermal stability, and surfactant properties. PFOA has been regularly found in the blood of animals and humans worldwide, and has become an increasing concern because of its adverse effects in immune system. However, the role of PFOA in the allergic inflammation is not well-known. To further extend the immunotoxicity of PFOA, we examined the role of PFOA on the mast cell-mediated allergic inflammation and studied the possible mechanism of action. PFOA dose- and time-dependently increased histamine release from mast cells and serum histamine by the induction of intracellular calcium. PFOA exacerbated the IgE-dependent local allergic reaction in the mouse allergy model. PFOA induced gene expression of pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8 in mast cells. The inducing effect of PFOA on the pro-inflammatory cytokines was nuclear factor-κB, p38 mitogen-activated protein kinase, and caspase-1 dependent. Furthermore, the activation of cyclooxygenase-2 by PFOA suggests the induction of allergic inflammatory mediators by the PFOA. Our findings provide evidence that PFOA, the known immunotoxic agent, induces mast cell-derived allergic inflammatory reactions by histamine release and expression of pro-inflammatory cytokines.

Topics: Animals; Calcium; Caprylates; Caspase 1; Cyclooxygenase 2; Dose-Response Relationship, Drug; Drug Hypersensitivity; Enzyme Activation; Female; Fluorocarbons; Histamine Release; Inflammation; Inflammation Mediators; Interleukin-1beta; Interleukin-6; Interleukin-8; Male; Mast Cells; Mice; Mice, Inbred BALB C; Mice, Inbred ICR; p38 Mitogen-Activated Protein Kinases; Tumor Necrosis Factor-alpha

The leukocyte migration test (LMT) is effective in identifying the causative drug in drug allergies. Both leukocyte migration activating activity (LMAA) and leukocyte migration inhibitory activity (LMIA) are involved in the development of drug allergies. However, no cytokines associated with LMIA have been identified to date. Because CXCL8 played an important role in neutrophil infiltration and activation, we performed the LMT and measured CXCL8 levels in patients with hypersensitivity to beta-lactam antibiotics (beta-lactams) and antipyretic analgesics (APAs) and investigated the pathogenic mechanism of hypersensitivity to these drugs.. The LMT was performed according to an improved version of the agarose plate method and CXCL8 levels in the reacted solution that had been stored as described were measured using a solid-phase sandwich enzyme-linked immunosorbent assay.. Migration index (MI) values for the LMT were 77.7 ± 11.7 for patients with hypersensitivity to beta-lactams and 83.6 ± 1.9 for those with hypersensitivity to APAs. The CXCL8 concentrations were significantly higher in patients after beta-lactams administration (175.9 ± 71.2 ng/mL) than those without beta-lactams administration (48.3 ± 34.9 ng/mL). The CXCL8 concentrations were significantly lower in patients after APAs administration (41.7 ± 24.3 ng/mL) than those without APAs administration (63.1 ± 30.2 ng/mL).. 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.

Topics: Adolescent; Adult; Anti-Bacterial Agents; beta-Lactams; Cell Migration Assays, Leukocyte; Cell Migration Inhibition; Child; Child, Preschool; Drug Hypersensitivity; Female; Humans; Interleukin-8; Leukocytes; Male; Middle Aged; Young Adult

Neutrophil chemotactic activity (NCA) following oral challenge with aspirin (ASA) was determined in ASA-intolerant asthmatic subjects, and in ASA-tolerant asthmatic and normal subjects. There was a statistically significant fall in FEV1 and a rise in NCA (P less than 0.01) following challenge in the ASA-sensitive subjects compared with that of the ASA-tolerant subjects and normal controls. No significant difference was observed between the latter two groups. The chemotactic factor identified in this study had a molecular weight greater than 150 000 which is consistent with NCF-A (neutrophil chemotactic factor of anaphylaxis). The ASA-induced fall in FEV1 and rise in NCA was further studied in three of the ASA-intolerant asthmatic subjects, with and without pretreatment with inhaled sodium cromoglycate. In these subjects, the drug inhibited both the oral ASA-induced bronchoconstriction and the increase in neutrophil chemotactic activity. These results suggest that ASA-induced asthma involves mediator release from mast cells, as shown by the increase in NCA following ASA challenge and the protective effect of sodium cromoglycate which is considered to inhibit mast-cell degranulation.

Topics: Adult; Aspirin; Asthma; Chemotactic Factors; Cromolyn Sodium; Drug Hypersensitivity; Female; Forced Expiratory Volume; Humans; Interleukin-8; Male; Mast Cells