JUST THE BASICS

In 1963, Philip Gell and Robin Coombs proposed a way to categorize drug allergies by the type of immune response that triggered them. The Gell & Coombs classification system is still used today, though some adjustments have been made over the years. This cartoon reimagines “Gell & Coombs” as a buddy cop duo of immune cells, investigating the mysterious origins of different allergic reactions occurring in the body. Throughout the cartoon, they identify the diagnostic features of an allergic reaction called DRESS, which stands for Drug Reaction with Eosinophilia and Systemic Symptoms*.

TELL ME SOMETHING NERDY

DRESS is a severe allergic reaction to a drug that can be life-threatening. There is also an interesting phenomenon in DRESS in which human herpesvirus-6 (HHV-6) appears in the blood, which can be used as a diagnostic marker for DRESS. Why do we see this? HHV-6 is the cause of roseola, a viral infection that most people get in childhood. HHV-6 is not completely cleared by the body; rather, it hides in white blood cells and can be reactivated later in life if the conditions are right. DRESS is one condition that allows HHV-6 to become reactivated. In DRESS, the body produces large numbers of a specific type of T cell that HHV-6 loves to grow in (OX40+CD4+ T cells, if you must know). This allows HHV-6 to replicate and turn positive in the blood. We don’t yet know why these specific T cells are activated in DRESS, though!

*Some countries use to the term “drug-induced hypersensitivity syndrome” (DIHS) instead of DRESS.

Published in February 2023 Annals of Allergy, Asthma & Immunology: https://doi.org/10.1016/j.anai.2022.10.007