Torres M J, Mayorga C, García J J, Romano A, Juarez C, Blanca M
Department of Internal Medicine, Carlos-Haya Hospital, Málaga, Spain.
Clin Exp Allergy. 1998 Sep;28 Suppl 4:25-8.
The data presented in this review confirm that penicillin continues to be the most well defined model for studying drug allergy. The identification of new specificities has improved the understanding of allergy to penicillins, and different well defined subgroups now exist. The capacity of humans to respond to unique penicillin determinants has shown that although penicillin is a very small molecule it can be recognized in different ways by different IgE antibodies. These well defined models have left open the possibility that other betalactams can also induce specific reactions which implies that for diagnostic purposes, in addition to classical determinants, others are required for in vitro and/or in vivo evaluation. When the different subgroups now recognized are compared, not only are there differences in the manner of hapten recognition but also in the evolution of the natural sensitivity and in the capacity for recognizing other structures. The recognition of betalactams by T cells is also important and a number of studies have shown that subjects respond specifically to some aminopenicillins or cephalosporins with good tolerance to benzylpenicillin. The confirmation that these responses can be a T-cell-mediated reaction have been reported not only in vitro by the generation of T cell lines and T cell clones but also in vivo doing skin biopsies in subjects who have developed different types of delayed cutaneous reactions [44]. More studies are needed to determine the structure of T cell epitopes and this will help for a better understanding of both the IgE and IgG-mediated reactions.
本综述中呈现的数据证实，青霉素仍然是研究药物过敏最为明确的模型。新特异性的鉴定增进了对青霉素过敏的理解，现在已存在不同明确的亚组。人类对独特青霉素决定簇产生反应的能力表明，尽管青霉素是一种非常小的分子，但不同的IgE抗体可以以不同方式识别它。这些明确的模型留下了一种可能性，即其他β-内酰胺类药物也可能引发特异性反应，这意味着出于诊断目的，除了经典决定簇外，还需要其他决定簇用于体外和/或体内评估。当比较目前所识别的不同亚组时，不仅在半抗原识别方式上存在差异，而且在自然敏感性的演变以及识别其他结构的能力方面也存在差异。T细胞对β-内酰胺类药物的识别也很重要，许多研究表明，受试者对某些氨基青霉素或头孢菌素会产生特异性反应，而对苄青霉素耐受性良好。这些反应可能是T细胞介导的反应这一点不仅在体外通过生成T细胞系和T细胞克隆得到了证实，而且在体内对出现不同类型迟发性皮肤反应的受试者进行皮肤活检时也得到了证实[44]。需要更多研究来确定T细胞表位的结构，这将有助于更好地理解IgE和IgG介导的反应。
