Advertisement

Central European Journal of Medicine

, Volume 9, Issue 1, pp 159–168 | Cite as

Pathophysiological characterization of drug hypersensitivity to tribenoside

  • Simona Zgažarová
  • Hana Jedličková
  • Zita Chovancová
  • Vojtěch Thon
Research Article

Abstract

Background

Tribenoside is a semisynthetic sugar derivative that is mainly indicated for treatment of chronic venous insufficiency. Up to 10% of patients treated by tribenoside can suffer from skin side effects. The adverse effects usually present as angioedema, urticaria, or maculopapular exanthema. The pathophysiology of the reaction has not as yet been elucidated.

Methods

In this study, we examined 22 patients with drug eruptions caused by tribenoside. Patch tests were performed to investigate in vivo cellular reactions. Laboratory investigations were carried out by lymphocyte transformation tests and basophil activation tests.

Results

We found a positive patch test reaction to tribenoside in one patient. The lymphocyte transformation test elicited a borderline positive reaction in one patient, and the basophil activation test gave a clearly positive reaction in another patient.

Conclusion

The diagnosis of drug hypersensitivity reactions is a challenge. Both delayed and immediate immunologic response may play a role in the etiology of tribenoside-induced exanthemas. Our investigation and results indicate that benzoic acid could be the antigenic determinant in drug hypersensitivity to tribenoside.

Keywords

Basophil activation test Benzoic acid Drug hypersensitivity Lymphocyte transformation test Patch test Tribenoside 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    Hashizume H., Takigawa M., Drug-induced hypersensitivity syndrome associated with cytomegalovirus reactivation: immunological characterization of pathogenic T cells, Acta Derm. Venereol., 2005, 85, 47–50PubMedCrossRefGoogle Scholar
  2. [2]
    Jaques R., The pharmacological activity of tribenoside, Pharmacology, 1977, 15, 445–460PubMedCrossRefGoogle Scholar
  3. [3]
    Kikkawa Y., Takaki S., Matsuda Y., Okabe K., Taniguchi M., Oomachi K., et al., The influence of Tribenoside on expression and deposition of epidermal laminins in HaCaT cells, Biol. Pharm. Bull., 2010, 33, 307–310PubMedCrossRefGoogle Scholar
  4. [4]
    Endo H., Kawada A., Yudate T., Aragane Y., Yamada H., Tezuka T., Drug eruption due to tribenoside, Contact Dermatitis, 1999, 41, 223PubMedCrossRefGoogle Scholar
  5. [5]
    Spáčil J., Pharmacotherapy of peripheral vascular diseases, In: Marek J. (Ed.), Pharmacotherapy of internal diseases, 3rd ed., Grada, Praha, 2005, 63–85Google Scholar
  6. [6]
    Schuppli R., Exantheme durch Glyvenol, Dermatologica, 1968, 137, 227–232PubMedCrossRefGoogle Scholar
  7. [7]
    Barbaud A., Goncalo M., Bruynzeel D., Bircher A., Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions, Contact Dermatitis, 2001, 45, 321–328PubMedCrossRefGoogle Scholar
  8. [8]
    Inoue A., Tamagawa-Mineoka R., Katoh N., Kishimoto S., Allergic contact dermatitis caused by tribenoside, Contact Dermatitis, 2009, 60, 349–350PubMedCrossRefGoogle Scholar
  9. [9]
    Posadas S.J., Pichler W.J., Delayed drug hypersensitivity reactions — new concepts, Clin. Exp. Allergy, 2007, 37, 989–999PubMedCrossRefGoogle Scholar
  10. [10]
    Barbaud A., Drug patch testing in systemic cutaneous drug allergy, Toxicology, 2005, 209, 209–216PubMedCrossRefGoogle Scholar
  11. [11]
    Brockow K., Romano A., Blanca M., Ring M., Pichler W., Demoly P., General considerations for skin test procedures in the diagnosis of drug hypersensitivity, Allergy, 2002, 57, 45–51PubMedGoogle Scholar
  12. [12]
    Wilkinson D.S., Fregert S., Magnusson B., Bandmann H.J., Calnan C.D., Cronin E., et al., Terminology of contact dermatitis, Acta Dermatovenereologica, 1970, 50, 287–292Google Scholar
  13. [13]
    Pichler W., Yawalkar N., Schmid S., Helbling A., Pathogenesis of drug-induced exanthems, Allergy, 2002, 57, 884–893PubMedCrossRefGoogle Scholar
  14. [14]
    Pichler W.J., Tilch J., The lymphocyte transformation test in the diagnosis of drug hypersensitivity, Allergy, 2004, 59, 809–820PubMedCrossRefGoogle Scholar
  15. [15]
    Thon V., Eggenbauer H., Wolf H.M., Fischer M.B., Litzman J., Lokaj J., et al., Antigen presentation by common variable immunodeficiency (CVID) B cells and monocytes is unimpaired, Clin. Exp. Immunol., 1997, 108, 1–8PubMedCentralPubMedCrossRefGoogle Scholar
  16. [16]
    Cederbrant K., Stejskal V., Broman P., Lindkvist L., Sundell K., In vitro lymphocyte proliferation in the diagnosis of allergy to phenoxymethylpenicillin, Allergy, 1998, 53, 1155–1161PubMedCrossRefGoogle Scholar
  17. [17]
    Sanz M.L., Gamboa P.M., De Weck A.L., In vitro tests: Basophil activation tests, In: Pichler W.J. (Ed.), Drug hypersensitivity, 1st ed., Karger, Basel, 2007, 391–402CrossRefGoogle Scholar
  18. [18]
    Sanz M.L., Gamboa P.M., Antépara I., Uasuf C., Vila L., Garcia-Avilés C., et al., Flow cytometric basophil activation test by detection of CD63 expression in patients with immediate-type reactions to betalactam antibiotics, Clin. Exp. Allergy, 2002, 32, 277–286PubMedCrossRefGoogle Scholar
  19. [19]
    Sioufi A., Pommier F., Biotransformation of tribenoside into benzoic acid in man, Eur. J. Drug Metab. Pharmacokinet., 1982, 7, 223–228PubMedCrossRefGoogle Scholar
  20. [20]
    Gregus Z., Fekete T., Halászi E., Gyurasics Á., Klaassen C.D., Effects of fibrates on the glycine conjugation of benzoic acid in rats, Drug metabolism. and disposition., 1998, 26, 1082–1088PubMedGoogle Scholar
  21. [21]
    Bell-Parikh L.C., Guengerich F.P., Kinetics of cytochrome P450 2E1-catalyzed oxidation of ethanol to acetic acid via acetaldehyde, J. Biol. Chem., 1999, 274, 23833–23840PubMedCrossRefGoogle Scholar
  22. [22]
    Amunom I., Stephens L.J., Tamasi V., Cai J., Pierce W.M. Jr., Conklin D.J., et al., Cytochromes P450 catalyze oxidation of alpha, beta-unsaturated aldehydes, Arch. Biochem. Biophys., 2007, 464, 187–196PubMedCentralPubMedCrossRefGoogle Scholar
  23. [23]
    Jacob S.E., Stechschulte S., Eyelid dermatitis associated with balsam of Peru constituents: benzoic acid and benzyl alcohol, Contact Dermatitis, 2008, 58, 111–112PubMedCrossRefGoogle Scholar
  24. [24]
    Rietschel R.L., Fowler J.F., Allergic sensitization to plants, In: Rietschel R.L., Fowler J.F. (Eds.), Fisher’s Contact Dermatitis, 6th ed., BC Decker Inc., Ontario, 2007, 405–453Google Scholar
  25. [25]
    Avalos-Peralta P., García-Bravo B., Camacho F.M., Sensitivity to Myroxylon pereirae resin (balsam of Peru). A study of 50 cases, Contact Dermatitis, 2005, 52, 304–306PubMedCrossRefGoogle Scholar
  26. [26]
    Tanaka S., Matsumoto Y., Dlova N., Ostlere L.S., Goldsmith P.C., Rycroft R.J. G., et al., Immediate contact reactions to fragrance mix constituents and Myroxylon pereirae resin, Contact Dermatitis, 2004, 51, 20–21PubMedCrossRefGoogle Scholar
  27. [27]
    Rajpara S., Wilkinson M.S., King C.M., Gawkrodger D.J., English J.S.C., Statham B.N., et al., The importance of propolis in patch testing-a multicentre survey, Contact Dermatitis, 2009, 61, 287–290PubMedCrossRefGoogle Scholar
  28. [28]
    Friedmann P.S., Lee M.S., Friedmann A.C., Barnetson R.C., Mechanisms in cutaneous drug hypersensitivity reactions, Clin. Exp. Allergy, 2003, 33, 861–872PubMedCrossRefGoogle Scholar
  29. [29]
    Nyfeler B., Pichler W.J., The lymphocyte transformation test for the diagnosis of drug allergy: sensitivity and specificity, Clin. Exp. Allergy, 1997, 27, 175–181PubMedCrossRefGoogle Scholar
  30. [30]
    Hari Y., Frutig-Schnyder K., Hurni M., Yawalkar N., Zanni M.P., Schnyder B., et al., T cell involvement in cutaneous drug eruptions, Clin. Exp. Allergy, 2001, 31, 1398–1408PubMedCrossRefGoogle Scholar
  31. [31]
    Bruynzeel D.P., Maibach H.I., Patch testing in systemic drug eruptions, Clinics in Dermatology, 1997, 15, 479–484PubMedCrossRefGoogle Scholar
  32. [32]
    Gex-Collet C., Helbling A., Pichler W.J., Multiple drug hypersensitivity — proof of multiple drug hypersensitivity by patch and lymphocyte transformation tests, J. Invest. Allergol. Clin. Immunol., 2005, 15, 293–296Google Scholar
  33. [33]
    Merk H.F., Diagnosis of drug hypersensitivity: lymphocyte transformation test and cytokines, Toxicology, 2005, 209, 217–220PubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Simona Zgažarová
    • 1
  • Hana Jedličková
    • 1
  • Zita Chovancová
    • 2
  • Vojtěch Thon
    • 2
  1. 1.1st Department of Dermatovenereology, St. Anne’s University HospitalMedical Faculty of Masaryk UniversityBrnoCzech Republic
  2. 2.Department of Clinical Immunology and Allergy, St. Anne’s University HospitalMedical Faculty of Masaryk UniversityBrnoCzech Republic

Personalised recommendations