薬剤性出血性大腸炎におけるアレルギー反応の関与―白血球遊走試験による検討―

Abstract

In 12 patients suspected of drug-associated hemorrhagic colitis, the identification of the allergenic drugs was made based on the findings of a leukocyte migration test (LMT) to study the value of LMT and also based on the presence of an allergic reaction in drug-associated hemorrhagic colitis.The LMT was positive in 8 (67%) of 12 cases. When it was absent in the patient' s serum, the positive rate was 3/12 (25%), whereas when it was present in the serum the rate increased to 7/10 (70%). Leukocyte migration activating factor (LMAF) was detected in 5 cases (42%) and leukocyte migration inhibitory factor (LMIF) was detected in 3 cases (25%). LMT-positive drugs were detected in 9 of all 41 suspected drugs, in which 6 drugs (67%) were β-lactam antibiotics and 2 drugs (22%) were nonsteroidal anti-inflammatory drugs and 1 drug (11%) was a hemostatic drug. Penicillin antibiotics accounted for 67% (4/6) in β-lactam antibiotics. Abnormal growth bacteria, i.e., K.oxytoca, Cl. Difficile, E. coli O-18 were detected in 3 cases by a bacteriological examination of a stool culture. However, all the 3 cases were positive for LMT.Our findings indicate that in drug-associated hemorrhagic colitis, an allergic reaction may play a major role and LMT may be highly useful for identifying such allergenic drugs. As a result, it may be important to add the patient's serum when performing the LMT. In addition, both LMAF and LMIF may be involved in the pathogenesis. β-lactam antibiotics may also be major drugs that can cause allergic hemorrhagic colitis. Furthermore, hemorrhagic colitis may be partly related to drug allergy even in cases where an abnormal growth of bacteria is detected.