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Highly Th2-Skewed Cytokine Profile of ß-Lactam-Specific T Cells from Nonatopic Subjects with Adverse Drug Reactions¹

Francesca Brugnolo^*, Francesco Annunziato^*, Salvatore Sampognaro^*, Paolo Campi, Mariangela Manfredi, Andrea Matucci^*, Miguel Blanca, Sergio Romagnani^2,*, Enrico Maggi^* and Paola Parronchi^*

^* Department of Internal Medicine, Section of Internal Medicine, Immunoallergology and Respiratory Diseases, University of Florence, Florence, Italy; Division of Allergology and Clinical Immunology, San Giovanni di Dio Hospital, Florence, Italy; and Allergy Laboratory, Carlos Haya Hospital, Malaga, Spain

A positive lymphocyte transformation test to ß-lactams (ß-L) was found in 12 of 29 subjects with adverse drug reaction (ADR) to ß-L, irrespective of either the type of clinical manifestation or the presence of specific serum IgE. Short-term T cell lines specific for penicillin G, amoxicillin, and ampicillin could be generated only from subjects with ADR (eight with positive and one with negative lymphocyte transformation test), while streptokinase and Dermatophagoides pteronyssinus group 1 (Der p 1)-specific T cells were obtained from all these subjects, from 7 atopic Der p-sensitive donors without history of ADR and 17 healthy nonatopic donors. Streptokinase-specific T cells from all subjects showed intracellular expression of IFN- with poor or no IL-4, whereas Der p 1-specific T cells exhibited IFN- but low or no IL-4 expression in nonatopics, and remarkable IL-4 expression in atopic donors. By contrast, all penicillin G-, ampicillin-, and amoxicillin-specific short-term T cell lines showed high intracellular expression of IL-4, IL-5, and IL-13, but poor or no expression of IFN-, thus exhibiting a clear-cut Th2 profile. Accordingly, most penicillin G-specific T cell clones derived from two subjects with ADR released high concentrations of IL-4 alone or IL-4 and IFN-. These data suggest that cytokines produced by Th2 cells play an important role in all ß-L-induced ADR, even when late clinical manifestations occur and an IgE-mediated mechanism is apparently indemonstrable.

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