Immunology of Cutaneous Adverse Drug Reactions

Abstract

Cutaneous adverse drug reactions (cADR) range from mild skin rash to life-threatening severe cutaneous adverse reactions (SCAR), which constitute a major clinical problem worldwide. Cutaneous adverse drug reactions show different clinical presentations, and most of them involve T cell-mediated immune response specific against drug/metabolite antigens, leading to the various phenotypes of cADR. This chapter focuses on the immune pathogenesis and reviews the cutting edge research on the molecular interaction of the human leukocyte antigens (HLA)/drug/T cell receptors (TCR), mechanism of T cell activation, and the downstream immune signaling of cytotoxic proteins as well as dysregulated cytokines/chemokines in cADR. Understanding the molecular interaction and regulation gives us new insights into the immune pathomechanism, the biomarkers for early diagnosis, and disease prevention as well as the development of therapeutic targets for the treatments of cADR.