The immunological mechanisms involved in drug hypersensitivity reactions (DHRs) are complex, and despite important advances, multiple aspects remain poorly understood. These not fully known aspects are mainly related to the factors that drive towards either a tolerant or a hypersensitivity response and specifically regarding the role of B and T cells. In this review, we focus on recent findings on this knowledge area within the last 2 years. We highlight new evidences of covalent and non-covalent interactions of drug antigen with proteins, as well as the very first characterization of naturally processed flucloxacillin-haptenated human leukocyte antigen (HLA) ligands. Moreover, we have analysed new insights into the identification of risk factors associated with the development of DHRs, such as the role of oxidative metabolism of drugs in the activation of the immune system and the discovery of new associations between DHRs and HLA variants. Finally, evidence of IgG-mediated anaphylaxis in humans and the involvement of specific subpopulations of effector cells associated with different clinical entities are also topics explored in this review. All these recent findings are relevant for the underlying pathology mechanisms and advance the field towards a more precise diagnosis, management and treatment approach for DHRs.

中文翻译：

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T 细胞和 B 细胞对药物抗原反应的进展和亮点

药物超敏反应 (DHR) 中涉及的免疫机制很复杂，尽管取得了重要进展，但仍对多个方面知之甚少。这些不完全了解的方面主要与驱动耐受或超敏反应的因素有关，特别是与 B 和 T 细胞的作用有关。在本次审查中，我们重点关注过去 2 年内该知识领域的最新发现。我们强调药物抗原与蛋白质共价和非共价相互作用的新证据，以及天然加工的氟氯西林半抗原人白细胞抗原 (HLA) 配体的首次表征。此外，我们分析了识别与 DHR 发展相关的风险因素的新见解，例如药物的氧化代谢在激活免疫系统中的作用以及发现 DHR 和 HLA 变体之间的新关联。最后，人类 IgG 介导的过敏反应的证据以及与不同临床实体相关的特定效应细胞亚群的参与也是本综述探讨的主题。所有这些最近的发现都与潜在的病理机制相关，并推动该领域朝着更精确的 DHR 诊断、管理和治疗方法发展。