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Lymphocyte transformation test in pediatric drug hypersensitivity: case series report from a tertiary care hospital

Olga Rogozina1, Susana Martín-López1, Fiorela Cinthia Dueñas López1

  • 1Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.

Frontiers in Immunology
|June 1, 2026
PubMed

Insights

The lymphocyte transformation test (LTT) shows high accuracy in diagnosing pediatric adverse drug reactions (ADRs), correlating with causality scores and drug provocation tests. LTT is a valuable non-invasive tool for identifying T-cell mediated reactions.

Area of Science:

  • Pharmacology
  • Immunology
  • Pediatrics

Background:

  • Diagnosing adverse drug reactions (ADRs) in children is complicated by concurrent infections.
  • There is a critical need for reliable in vitro diagnostic methods for pediatric ADRs.

Purpose of the Study:

  • To assess the lymphocyte transformation test (LTT) for supporting the Spanish Pharmacovigilance System (SPS) causality algorithm in pediatric ADRs.
  • To determine the diagnostic accuracy of the SPS algorithm, LTT, skin tests, and drug provocation testing (DPT) for pediatric ADRs.

Main Methods:

  • A retrospective case-series study (2018-2024) involving 81 children with adjudicated ADRs at a tertiary hospital.
  • The reference standard was tolerance upon drug re-exposure to calculate sensitivity, specificity, and predictive values.
  • Analysis included correlating LTT results with SPS causality scores and DPT outcomes.

Main Results:

  • The study analyzed 81 children, with cutaneous and hepatic ADRs being most common.
  • Frequent culprit drugs included amoxicillin, paracetamol, amoxicillin/clavulanic acid, and ibuprofen.
  • LTT demonstrated 100% sensitivity and 100% negative predictive value, with 78% specificity. LTT positivity significantly correlated with SPS scores ≥4 (p<0.001) and DPT outcomes (p=0.008).

Conclusions:

  • LTT positivity in children significantly correlates with high causality scores and drug provocation test results.
  • The lymphocyte transformation test is a valuable, non-invasive tool for diagnosing T-cell mediated adverse drug reactions.
  • LTT is particularly useful when drug provocation testing poses risks or is contraindicated in pediatric patients.
Abstract

Keywords:
adverse drug reaction (ADR)causality algorithmdiagnostic accuracydrug hypersensitivitydrug provocation test (DPT)lymphocyte transformation test (LTT)pediatricspharmacovigilance

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