Predictive drug allergy testing: an alternative viewpoint

T- and B-cells recognise drugs when bound as haptens to carrier molecules. Recent studies suggest that drugs might also bind in a non-covalent form to MHC-peptide complexes and T cell receptors. and are thereby able to stimul ate T cells. This has, however, only been shown for dug-specific T cell clo nes. Functional analysis: revealed that drug-reactive T cells secrete high amounts of IL-5 and are cytotoxic. Cytotoxicity is: mediated by drug-specif ic CD4(+) and CD8(+) cells and, as revealed by the immunohistochemical anal ysis of drug-induced exanthems. might be involved in the killing of keratin ocytes thus explaining the drug-induced exanthem. Further work is needed to clarify the type and exact location of the rather labile drug binding to M HC and T cell receptors. and to evaluate what drug allergies might be cause d by such an unusual presentation;ind immune stimulation. This new model as well as findings from the analysis of clinical drug allergies may have maj or implications on how to test and predict the allergenic potential of drug s. A change and expansion of currently performed test procedures is require d to predict the allergenic potential of drugs. (C) 2001 Elsevier Science i reland Ltd. All rights reserved.