Université Lyon1, UFR Lyon Sud, Oullins 69600, France.
Curr Opin Allergy Clin Immunol. 2009 Aug;9(4):305-10. doi: 10.1097/ACI.0b013e32832d565c.
This review presents the current knowledge of the role of T cells in drug allergy manifesting as exanthematous, pustular and bullous skin diseases, collectively referred to as nonimmediate allergic drug reactions.
Both CD4+ and CD8+ T cells producing type 1 and type 2 cytokines and endowed with cytotoxic properties are involved in nonimmediate allergic drug reactions. Recent studies have confirmed that CD8+ T cells play a major role in the pathophysiology of nonimmediate allergic drug reactions, and have characterized new cytotoxic molecular pathways responsible for the severity of the bullous forms of nonimmediate allergic drug reactions.
Nonimmediate allergic drug reactions are mediated by T cells and mostly affect the skin. Nonimmediate allergic drug reactions comprise several diseases ranging from the frequent and benign maculo-papular exanthema to the severe and rare toxic epidermal necrolysis. Progress in the knowledge of the pathophysiology of nonimmediate allergic drug reactions comes from a better understanding of the mechanisms of drug recognition by T cells and from a careful analysis of the phenotype and functions of CD4+ and CD8+ T cells infiltrating the skin lesions. Recent studies have confirmed that the different clinical forms of nonimmediate allergic drug reactions are associated with distinct types of T cell-mediated skin inflammation. However, CD8+ T cells appear as major effector T cells in most of the nonimmediate allergic drug reactions. Future studies to analyze the early cellular and molecular events leading to the development of the allergic skin reaction will be helpful in order to define diagnostic and therapeutic targets.
本文综述了 T 细胞在以发疹、脓疱和大疱性皮肤病为表现的药物过敏中的作用，即通常所说的非即刻过敏药物反应。
产生 1 型和 2 型细胞因子的 CD4+和 CD8+T 细胞以及具有细胞毒性的 T 细胞均参与非即刻过敏药物反应。最近的研究证实 CD8+T 细胞在非即刻过敏药物反应的病理生理学中起主要作用，并鉴定了新的细胞毒性分子途径，这些途径与非即刻过敏药物反应的大疱形式的严重程度有关。
非即刻过敏药物反应由 T 细胞介导，主要影响皮肤。非即刻过敏药物反应包括多种疾病，从常见且良性的斑丘疹到严重且罕见的中毒性表皮坏死松解症。非即刻过敏药物反应的病理生理学知识的进展源于对 T 细胞识别药物机制的更好理解，以及对浸润皮肤损伤的 CD4+和 CD8+T 细胞表型和功能的仔细分析。最近的研究证实，非即刻过敏药物反应的不同临床形式与不同类型的 T 细胞介导的皮肤炎症有关。然而，在大多数非即刻过敏药物反应中，CD8+T 细胞似乎是主要的效应 T 细胞。分析导致过敏皮肤反应发生的早期细胞和分子事件的未来研究将有助于确定诊断和治疗靶点。
