Abstract
Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated.DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions.One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic.
Highlights
Several types of drugs can cause drug-induced interstitial lung disease (DILD)
In its more severe manifestation, DILD may result in respiratory failure and acute respiratory distress syndrome
DILD may develop within the first few days of treatment or may not until several years after treatment
Summary
Several types of drugs can cause drug-induced interstitial lung disease (DILD). The incidence of DILD for each individual drug is variable. A central role for T lymphocytes in the immunologic reaction to MIP was suggested by Gillon et al, who identified lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages in vitro [42] Their findings, do not explain the presence of pulmonary eosinophilia, which is a characteristic feature of MIP. Various reports have drawn attention to the positive results of this test in cases of DILD due to different drugs, such as minocycline, amiodarone, propranolol, nitrofurantoin, gold salts, MTX, and paclitaxel [41,57,58,59,60,61]. DPT was performed in 58cases, 41 of which showed positive results This test was initiated by administering the lowest dosage of the suspected causal drug that could achieve a response, and gradually increasing the dose at daily intervals until a normal daily dose was reached or symptoms occurred. Genotyping prior to drug prescription may be clinically useful for predicting and preventing DILD
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