Nonimmediate reactions to betalactams.

Full Abstract

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.

Author information

Author/s: Lopez, Soledad (S); Blanca-Lopez, Natalia (N); Cornejo-Garcia, Jose Antonio (JA); Canto, Gabriela (G); Torres, Maria Jose (MJ); Mayorga, Cristobalina (C); Blanca, Miguel (M);

Affiliation: Research Laboratory, Carlos Haya Hospital-Fundacion IMABIS, Málaga, Spain.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: Current opinion in allergy and clinical immunology (Curr Opin Allergy Clin Immunol), published in United States. (Language: eng)

Reference: 2007-Aug; vol 7 (issue 4) : pp 310-6

Dates: Created 2007/07/10; Completed 2007/09/21;

PMID: 17620822, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

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