Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpesviruses and antiviral and antidrug immune responses.
Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpesviruses and antiviral and antidrug immune responses.
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DOI：
10.2332/allergolint.55.1
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发表时间：
2006-03-01
期刊：
影响因子：
--
通讯作者：
Kano, Yoko
中科院分区：
文献类型：
--
作者：
Shiohara, Tetsuo;Inaoka, Miyuki;Kano, Yoko
在各种临床情况中经常观察到病毒感染与同时或随后发生的过敏性炎症之间的关系。最近的研究表明，包括人类疱疹病毒 6 (HHV-6) 在内的疱疹病毒的重新激活与称为药物诱发的超敏反应综合征 (DIHS) 的严重全身性超敏反应的发生之间存在密切关系。该综合征有几个重要的临床特征，不能仅用药物抗原驱动的 T 细胞寡克隆扩增来解释：它们包括停药后临床症状的矛盾恶化。鉴于与GVHD或免疫重建综合征（IRS）在临床表现和病毒感染出现方面的相似性，DIHS和GVHD过程中观察到的临床症状很可能是由可分别与药物和同种抗原交叉反应的抗病毒T细胞介导的。考虑到致病药物可能诱发免疫抑制的共同内在特性，重建对这些病毒的有效免疫反应（通常在 IRS 中观察到）可能是 DIHS 患者停用致病药物后发生的最关键的过程。因此，该综合征应被视为由几种疱疹病毒（EB病毒、HHV-6、HHV-7和巨细胞病毒）、抗病毒免疫反应和药物特异性免疫反应之间复杂的相互作用引起的反应。本综述包括对病理机制、临床症状、实验室检查结果、病理结果和治疗的讨论。
A relationship between viral infections and the simultaneous or subsequent development of allergic inflammation has often been observed in various clinical situations. Recent studies suggest an intimate relationship between reactivations of herpesviruses including human herpesvirus 6 (HHV-6) and the development of a severe systemic hypersensitivity reaction referred to as drug-induced hypersensitivity syndrome (DIHS). This syndrome has several important clinical features that cannot be solely explained by drug antigen-driven oligoclonal expansion of T cells: they include paradoxical worsening of clinical symptoms after discontinuation of the causative drug. In view of the similarity to GVHD or immune reconstitution syndrome (IRS) in clinical manifestations and emergence of viral infections, the clinical symptoms observed during the course of DIHS and GVHD are likely to be mediated by antiviral T cells that can cross-react with the drug and alloantigens, respectively. In considering common intrinsic properties of the causative drugs to potentially induce immunosuppression, reconstitution of a valid immune response to these viruses, which is typically observed in IRS, may be the most crucial process that takes place after withdrawal of the causative drug in patients with DIHS. Thus, this syndrome should be regarded as a reaction induced by a complex interplay among several herpesviruses (EB virus, HHV-6, HHV-7, and cytomegalovirus), antiviral immune responses, and drug-specific immune responses. This review includes discussion of the pathomechanism, the clinical symptoms, laboratory findings, pathological findings and therapy.