Gene Expression Levels of Cytokine Profile and Cytotoxic Markers in Non-Immediate Reactions to Drugs

Drugs can induce IgE mediated or T cell dependent immunological reactions. T cell dependent reactions are poorly understood, although T lymphocytes have been proposed as a protagonist in a number of non-immediate immunological reactions (NIR). The objective was to study in vivo different regulatory and proinflammatory cytokines and cytotoxic markers in patients with NIR to drugs. Twenty patients with NIR after drug intake were classified into two groups: Group A (severe), Stevens–Johnson syndrome and toxic epidermal necrolysis; and Group B (mild), maculopapular exanthema and desquamative exanthema. Another 25 subjects taking the same drugs but without reactions formed a control group. Samples were obtained within 24 hours of the reaction and 30 days later. IL-2, IL-4, IFN, TNF, perforin, granzyme B (GrB), and FasL mRNA expression levels were determined in peripheral blood mononuclear cells by competitive RT-PCR. There were 9 patients in Group A and 11 in Group B. The drugs involved were betalactams (8), anticonvulsants (6), allopurinol (1), sulfamethoxazole (1), amiodarone (1) dypirone (2), and erythromicine+paracetamol (1). At the acute stage there was a high increase of IL-2, IFN, and TNF mRNA expression in both groups vs. controls, perforin and GrB varied in each group with patients in Group A having the highest values, and FasL was only expressed in Group A. Relationships between the cytokines were only significant in Group B (p< 0.05). Only the relation between IFN-γ and TNF-α was significant in Group A. There was a significant correlation between cytotoxic markers in both groups (A: p< 0.001, B: p< 0.01). These data demonstrate the complexity of the Th1 phenotype in NIR after drug intake. In patients with mild NIR, cytokines appear to play a closely related role, whereas cytotoxic markers appear more relevant in severe reactions.