Drug-lymphocyte stimulation test

Suzuki Y, Miwa S, Shirai M, Ohba H, Murakami M, Fujita K, Suda T, Nakamura H, Hayakawa H, Chida K. Drug lymphocyte stimulation test in the diagnosis of adverse reactions to antituberculosis drugs. Chest 2008 134(5) 1027-32. 

A 56-year-old patient with rheumatoid arthritis, who was started on INH chemoprophylaxis for a positive tuberculin skin test, developed interstitial pneumonia 2 weeks after the start of INH. The result of Drug Lymphocyte Stimulation Test (DLST) for INH was positive with the peripheral blood lymphocytes (stimulation index 208%). Trans-Bronchial Lung Biopsy specimens showed cellular no specific interstitial pneumonia pattern... 

The positive lymphocyte stimulation test, the eosinophils, and the low blood concentrations 3 days after withdrawal suggest that hypersensitivity to troghtazone was the underlying cause. The authors reported that another patient with hepatitis after troghtazone had had a subacute course after withdrawal of the drug. 

A 29-year-old man developed an infiltrative maculo-papular eruption after 1 week of itraconazole 100 mg bd for tinea corporis (44). Itraconazole was withdrawn, and the lesions disappeared within 7 days. Scratch tests, patch tests, scratch-patch tests, and drug induced lymphocyte stimulation tests for itraconazole were negative however, rechallenge with systemic itraconazole induced a maculopapular eruption on the face, hands, and the dorsa of the feet. Empty itraconazole capsules had no cutaneous effects, suggesting an allergic reaction to a metabolite of the compound. 

In addition to these cases, 37 cases of drug eruption due to mexiletine have been reported in Japan, with several common clinical features (37). The interval between initial drug therapy and the start of the eruption was relatively long (48-88 days) there was a high proportion of positive patch tests (86-97%) but a low incidence of positive lymphocyte stimulation tests (23-27%) there were frequent systemic symptoms, such as fever (93-94%) and liver dysfunction (43-78%) finally, some patients had multiple drug eruptions. 

A 62-year-old woman with severe asthma took oral pranlukast 450 mg/day and oral prednisolone 80 mg/day for a severe asthmatic attack. After oral prednisolone was tapered and subsequently withdrawn by day 35, she was maintained on pranlukast only and 5 days later had fever, deteriorating pulmonary symptoms, hypoxemia, and bibasal reticulonodular pulmonary infiltrates on chest CT. A transbronchial biopsy was consistent with drug-related interstitial pneumonitis. A lymphocyte stimulation test was positive for pranlukast. Her fever abated and her pulmonary symptoms markedly improved 3 days after withdrawal of pranlukast, and 5 months later the pulmonary infiltrates had completely resolved. 

Tsuda T, Yashiro S, Game Y, Watanabe K, Hoshino T, Oikawa T, Hanawa T. Discrepancy between clinical course and drug-induced lymphocyte stimulation tests in a case of saireito-induced liver injury accompanied by SjOgren syndrome. J Altem Complement Med 2010 16(4) 501-5. 

A case of pneumonia induced by L-carbocy steine was published [95 ]. A 32-year-old patient with CATCH22 syndrome was diagnosed with drug-induced pneumonia after a drug-induced lymphocyte stimulation test came back positive only for carbocysteine. The patient had a previous similar episode, with the only common medication in both episodes being carbocysteine, supporting the causality. 

The in vitro methods recommended for the diagnosis of drug allergy have as yet seldom been applied in Lyell s syndrome. Specific stimulation has been demonstrated in the lymphocyte transformation test in a few cases, but only when the test was carried out within a few weeks of recovery (Schopf et al, 1975). 

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