Lopez Soledad, Blanca-Lopez Natalia, Cornejo-Garcia Jose Antonio, Canto Gabriela, Torres Maria Jose, Mayorga Cristobalina, Blanca Miguel
Research Laboratory, Carlos Haya Hospital-Fundacion IMABIS, Málaga, Spain.
Curr Opin Allergy Clin Immunol. 2007 Aug;7(4):310-6. doi: 10.1097/ACI.0b013e3281e209fe.
Nonimmediate reactions to beta-lactams include several clinical entities, from maculopapular rash to severe reactions such as Steven-Johnson syndrome. Toxic epidermal necrolysis and organ-specific reactions may also occur.
Progress has been made in understanding the role of the immunological system in nonimmediate reactions to beta-lactams. Different T-cell subsets recognize beta-lactams after haptenation of serum or cell proteins in the context of major histocompatibility complex. Studies using T-cell lines and clones have shown that a heterogeneous response is generated, with the expression of different cytokine profiles. Betalactams also act on dendritic cells, inducing changes that enable them to interact with naïve lymphocytes, becoming memory T cells. Tissue-activated CD4 and CD8 cells express perforin and other cytotoxic mediators that elicit the lesions. Studies on the clinical course of these entities indicate that cells migrate, establishing a recirculation with homing to the skin and back to the circulation. These cells thus participate not only in skin lesions but probably also in the repair process.
Understanding the immunological mechanisms involved in nonimmediate reactions to beta-lactams has improved over the last few years, with better definition of the different T-cell subpopulations involved. Experimental studies and monitoring of the response support the implication of different cell subsets.
β-内酰胺类药物的非即刻反应包括多种临床情况，从斑丘疹到严重反应如史蒂文斯-约翰逊综合征。还可能发生中毒性表皮坏死松解症和器官特异性反应。
在理解免疫系统在β-内酰胺类药物非即刻反应中的作用方面取得了进展。不同的T细胞亚群在主要组织相容性复合体的背景下识别血清或细胞蛋白半抗原化后的β-内酰胺类药物。使用T细胞系和克隆进行的研究表明，会产生异质性反应，伴有不同细胞因子谱的表达。β-内酰胺类药物还作用于树突状细胞，诱导使其能够与幼稚淋巴细胞相互作用并成为记忆T细胞的变化。组织活化的CD4和CD8细胞表达穿孔素和其他细胞毒性介质，引发病变。对这些情况临床过程的研究表明，细胞迁移，建立起归巢至皮肤并回到循环系统的再循环。因此，这些细胞不仅参与皮肤病变，还可能参与修复过程。
在过去几年中，对β-内酰胺类药物非即刻反应所涉及的免疫机制的理解有所改善，对所涉及的不同T细胞亚群有了更明确的定义。实验研究和反应监测支持不同细胞亚群的参与。
