Clinical Analysis of Drug Allergy by the Molecular Targeting Drug: Imatinib Mesilate (Glivec Capsules^®): A New Type of Adverse Drug Eruption Through Activation of the IL5 Gene?

Abstract

We report a 64-year-old male case of drug eruption that arose during the chemotherapy with new molecular-targeting drug Imatinib Mesilate (Glivec Capsules) for chronic myelogenous leukemia. The patient developed a generalized maclopapular rash with high fever and eosinophilia (%) 10 days after the start of daily administration of the drug (400 mg/day). This episode subsided with oral predonisolone and anti-histamine and topical corticosteroid ointment. Drug-induced lymphocyte stimulation test, scratch, and patch tests with Imatinib Mesilate all gave negative results. An oral challenge test reproduced a similar maculopapular rash at the high dose of Imatinib Mesilate. Our final diagnosis was a drug eruption due to Imatinib Mesilate. However, this drug induces IL5 mRNA in peripheral blood mononuclear cell from either normal controls or the patient, which suggests that Imatinib Mesilate might transactivate the IL5 gene, resulting in cutaneous rash through eosinophilpoiesis. Clinical analysis of this case of drug eruption due to Imatinib Mesilate revealed that most of the patients tolerate moderate doses of the drug (100–300 mg/day) well without recurrance of the skin rash. These clinical and immunological analyses indicate that the drug eruption induced by Imatinib Mesilate may be induced through nonspecific activation of the IL5 gene in these patients.