Molecular features of penicillin allergy.

Haptens, such as drugs and other low molecular weight chemicals, become immunogenic only upon binding to proteins. Among antibiotics, penicillins are most commonly used for the treatment of bacterial infections and constitute a typical example of allergy inducing drugs in humans. Previous work on their immunologic properties focused mainly on the examination of IgE-mediated hypersensitivity reactions; however, drug-specific T cell reactions are also involved in causing a serious allergic inflammatory response. This review will focus on the interaction between antibiotic molecules and penicillin-specific T lymphocytes in humans. Experimental data accumulated so far on the reactivity of T cells with penicillin G point to penicilloyl-modified, major histocompatibility complex-associated peptides as T cell epitopes. The recognition specificity of the respective T cell receptors appears to be directed at both the backbone and the specific side chain of penicillin. In contrast, the sequence of the carrier peptides appears to contribute little to the antigenic specificity, mainly as a holder for the haptenic determinant. Finally, recent results demonstrating the capacity of penicillins to modulate, in vitro, the Th0/Th2 phenotype of established T cell clones will be presented and discussed in relation to possible therapeutic applications.