Distinct Serum Cytokine Levels in Drug– and Measles–Induced Exanthema

BACKGROUND: Macular or maculopapular skin reactions are frequent events in drug allergy as well as in viral infections. Clinically, the differentiation may be difficult in the absence of a clear relationship to drug intake or failure to detect virus-specific antibodies of the IgM class. Studies on drug-specific T cell lines and T cell clones isolated from drug-allergic patients have suggested that these cells may represent a significant source of IL-5. On the other hand, viral infections are frequently associated with elevated IFN-gamma levels. OBJECTIVE: Determination of serum-cytokine levels to differentiate between drug- and virally induced skin eruptions. PATIENTS: 18 patients suffering from acute drug allergy and 19 patients with acute measles, rubella or parvovirus infection. MEASUREMENTS: Cytokine-ELISA (IL-5, IL-4 and IFN-gamma) of sera collected during acute drug allergy or during acute measles, rubella or parvovirus infection. RESULTS: In 12/18 patients with drug allergy, IL-5 and/or IL-4 were elevated. A significant correlation (r(Spearman) = 0.84) between IL-5 serum levels and eosinophil counts in the blood was found. No correlation was detected between IL-4 and blood eosinophilia or between IL-4 and IL-5 levels. After remission, IL-5 and IL-4 decreased to undetectable levels. IFN-gamma on the other hand was not measurable in patients with drug allergy while elevated IFN-gamma serum levels were detected in 17/19 patients with measles, rubella or parvovirus infection; 2 patients with acute virus infection had elevated IL-5, and/or IL-4 and IFN-gamma levels. CONCLUSION: These data underline the distinct pathogenesis of these morphologically similar exanthemas and suggest that the combined analysis of eosinophilia in the blood, IL-4 and IFN-gamma might help in differentiating skin eruptions.