Abstract
Virus infections and T cell-mediated drug hypersensitivity reactions
(DHR) can influence each other. In most instances, systemic virus
infections appear first. They may prime the reactivity to drugs in
two ways: First, by virus-induced second signals: certain
drugs like β-lactam antibiotics are haptens and covalently bind to
various soluble and tissue proteins, thereby forming novel antigens.
Under homeostatic conditions, these neo-antigens do not induce an immune
reaction, probably because co-stimulation is missing. During a virus
infection, the hapten-modified peptides are presented in an
immune-stimulatory environment with co-stimulation. A drug-specific
immune reaction may develop and manifest as exanthema. Second, by
increased pharmacological interactions with immune receptors (p-i) :
drugs tend to bind to proteins and may even bind to immune receptors. In
the absence of viral infections, this low affine binding may be
insufficient to elicit T cell activation. During a viral infection
immune receptors are more abundantly expressed and allow more
interactions to occur. This increases the overall avidity of p-i
reactions and may even be sufficient for T cell activation and symptoms.
There is a situation, where the virus-DHR sequence of events is
inversed: in drug reaction with eosinophilia and systemic symptoms
(DRESS), a severe DHR can precede reactivation and viremia of various
herpes viruses. One could explain this phenomenon by the massive p-i
mediated immune stimulation during acute DRESS, which coincidentally
acvitates many herpes virus-specific T cells. Through p-i stimulation,
they develop a cytotoxic activity with killing of herpes
peptide-expressing cells and release of herpes viruses. These concepts
could explain the often transient nature of DHR occurring during viral
infections and the often asymptomatic herpes-virus viraemia after DRESS.