Preprint Communication Version 1 Preserved in Portico This version is not peer-reviewed

Value of the Lymphocyte Transformation Test for the Diagnosis of Drug-Induced Hypersensitivity Reactions in Severe Hospitalized COVID-19 Patients

Calos Fernández-Lozano
,
Emilio Solano Solares
ORCID logo ,
Isabel Elías-Sáenz
,
Isabel Pérez-Allegue
,
Monserrat Fernández-Guarino
ORCID logo ,
Diego Fernández-Nieto
,
Laura Díaz Montalvo
ORCID logo ,
David González-de-Olano
,
Ana De Andrés
,
Javier Martínez-Botas
* ORCID logo ,
Belén De la Hoz Caballer
*
Version 1 : Received: 29 June 2023 / Approved: 29 June 2023 / Online: 29 June 2023 (13:57:05 CEST)

A peer-reviewed article of this Preprint also exists.

Fernández-Lozano, C.; Solano Solares, E.; Elías-Sáenz, I.; Pérez-Allegue, I.; Fernández-Guarino, M.; Fernández-Nieto, D.; Díaz Montalvo, L.; González-de-Olano, D.; de Andrés, A.; Martínez-Botas, J.; de la Hoz Caballer, B. Value of the Lymphocyte Transformation Test for the Diagnosis of Drug-Induced Hypersensitivity Reactions in Hospitalized Patients with Severe COVID-19. Int. J. Mol. Sci. 2023, 24, 11543. Fernández-Lozano, C.; Solano Solares, E.; Elías-Sáenz, I.; Pérez-Allegue, I.; Fernández-Guarino, M.; Fernández-Nieto, D.; Díaz Montalvo, L.; González-de-Olano, D.; de Andrés, A.; Martínez-Botas, J.; de la Hoz Caballer, B. Value of the Lymphocyte Transformation Test for the Diagnosis of Drug-Induced Hypersensitivity Reactions in Hospitalized Patients with Severe COVID-19. Int. J. Mol. Sci. 2023, 24, 11543.

Abstract

In the first wave of COVID-19, up to 20% of patients had skin lesions with variable characteristics. There is no clear evidence of the involvement of the SARS-CoV-2 virus in all the cases; some of these lesions may be secondary to drug hypersensitivity. To analyze the possible cause of the skin lesions, we performed a complete allergology study on 11 patients. One year after recovery from COVID-19, we performed a lymphocyte transformation test (LTT) and Th1/Th2 cytokine secretion assays of PBMC. We included 5 nonallergic patients treated with the same drugs without lesions. Except for one patient who had an immediate reaction to azithromycin, all patients had a positive LTT to at least one of the drugs tested (azithromycin, clavulanic acid, hydroxychloroquine, lopinavir, and ritonavir). None of the nonallergic patients had a positive LTT. We found mixed Th1/Th2 cytokine secretion (IL-4, IL-5, IL-13, and IFN-γ) in patients with skin lesions corresponding to mixed drug hypersensitivity type IVa and IVb. In all cases, we identified a candidate drug as the culprit for skin lesions during SARS-CoV-2 infection, although only three patients had a positive drug challenge. Therefore, it would be reasonable to recommend avoiding the drug in question in all cases.

Keywords

delayed drug hypersensitivity; skin reaction; SARS-CoV-2; LTT; interleukins

Subject

Medicine and Pharmacology, Immunology and Allergy

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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