EPITOMES- phils to leukotriene B4. Although much is still unknown disorders. Quantitation of helper/suppressor T cells may regarding the role of the leukotrienes in inflammation, be clinically useful in certain suspected immunologic their potency and ubiquity make them strong candidates disorders. In infants, it can be used to distinguish as inflammatory mediators or modulators in many disease between transient (reduced processes involving recruitment of inflammatory cells. helper T cells) and congenital agammaglobulinemia Present efforts are being directed toward the development (normal helper/suppressor T cells and absent B cells). In of specific inhibitors of leukotriene formation. Such adults, T-cell subsets are most often measured in the agents would be very useful for basic research on the evaluation of persons suspected of having the acquired interaction of arachidonic acid metabolites and of great immune deficiency syndrome (AIDS). While a reduced therapeutic potential in the treatment of , rheuma- number (and percent) of helper T cells with a normal or toid arthritis or other related conditions. increased percent of suppressor cells is almost uniformly Elucidation of increasing numbers of surface receptors found in patients who have AIDS, these findings are very for diverse chemoattractants on neutrophils, together with nonspecific and, in themselves, not diagnostic. More- the understanding that the various neutrophil functions over, altered helper/suppressor T-cell ratios are found are triggered by occupation of these receptors, provides after a viral infection and in many sexually active basic information for a clearer understanding of neutro- homosexual men who do not have AIDS. Thus, while an phil function in inflammatory conditions and will likely abnormal helper/suppressor T-cell ratio is a characteristic provide clinicians with more disease-specific and effec- immunologic finding useful in confirming the diagnosis tive therapies in the near future. of AIDS, it is by no means diagnostic of the disorder. In MARK P. FLETCHER. MD other adult , such as common variable Davis, Cilifornia , T-cell subsets (by the generally used REFERENCES markers) are often abnormal but appear to have no Fletcher MP. Gallin JI: Modulation of PMN receptors for chemlotactic peptides. relationship to the in vivo or in vitro functional defects Surv Imimilunol Res 1983 Jun, 2:139-144 Goldimian DW. Goetzl EJ: Specitic binding of leukotriene B4 to receptors on observed. humiian polymilorphonuclear leukocytes. J Imimiilunol 1982 Oct, 129:1600-1604 Measurement of helper/suppressor T cells is not a Haiimmerschmi'dt DE. White JG. Craddock PR. et al: Corticosteroids inhibit screening test. In selected patients with possibly ab- conmplenment-induced granulocyte aggregation-A possible mechanismz for their eflicacy in shock states. J Clin Invest 1979 Apr; 63:798-803 normal T-cell function, it should be used in conjunction Marx JL: The leukotrienes in allergy and inflailtilmation. Science 1982 Mar 12: with other tests of immune function such as a battery of 215:1380-1383 delayed skin tests. It is important to emphasize that patients should not be labelled as having Clinical Significance of an ''immune disorder" or ''dysfunction' solely on the Helper/Suppressor T Cells basis of an in vitro morphologic determination of helper/ THE MORPHOLOGICAL determination (typing) of the per- suppressor T cells. ANDREW SAXON. MD cent and absolute number of circulating T-"helper" and Los An,g,,eles -"suppressor" lymphocytes has gained widespread popu- larity with the development of monoclonal to REFERENCES Detels R. Fahey JL. Schwartz K. et al: Relation between sexual practices and detect antigens on the surface of different subpopulations T-cell subsets in honmosexually active nten. Lancet 1983 Mar 19; 1:609-611 of human lymphocytes. In this context, the terms T Reinherz EL. Schlossnman SF: Current concepts in : Regulation of the -Inducer and suppressor T-lyrilphocyte subsets in human "helper" and "suppressor," which are functional terms, beings. N EngI J Med 1980 Aug 14; 303:370-373 are gross oversimplifications. The helper T cells, as Thomas Y. Rogozinski L. Irigoyen OH. et al: Functional analysis of human subsets delined by monoclonal antibodies-V. Suppressor cells within the detected by the monoclonal antibodies in general use such activated OKT4+ population belong to a distinct subset. J Immilunol 1982 Mar: as T4, contain not only helper cells for immunoglobulin 128: 1386-1390 synthesis but also inducer cells for many T-cell functions and even the precursors of some suppressor T cells. Thus, the T-helper/inducer population is really a mixture Penicillin-induced of related but distinct T cells. These distinctions based on OF AN ESTIMATED 400 to 800 anaphylactic deaths per function can be delineated immunologically by other year in the United States, as many as 75 % have been monoclonal antibodies not in general use. Similarly, the ascribed to penicillin sensitivity. Anaphylaxis may occur suppressor T cells defined by monoclonal antibodies such in one to four instances per 10,000 patient treatment as T8 comprise a variety of cell types involved in courses. The death rate is about 1 to 2 per 100,000 and in inhibition of immune responses. patients treated. The oral route appears to be the safest The measurement of helper and suppressor T-cell but reactions and even death have occurred from numbers, percents and ratios can be compared with the penicillin taken orally. Children are at lower risk than measurement of different types of leukocytes by differen- adults. tial cell count. Values may be abnormal in many cases Penicillin is the only drug whose allergenic metabolites but the clinical utility is limited to a very small number have been identified. The penicilloyl moiety, formed in of disorders. Furthermore, while the test is very sensi- largest quantity and thus called the major determinant, is tive, it is also nonspecific, being altered in many responsible most often for accelerated urticarial reactions. infectious (especially viral), metabolic, neoplastic, rheu- A skin test reagent for detecting sensitivity to this matologic and congenital and acquired immunologic determinant is available commercially as penicilloyl-poly-

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