EL CONCEPTO P-I: UNA NUEVA TEORÍA INMUNOLÓGICA SOBRE LAS REACCIONES CUTÁNEAS ASOCIADAS A FÁRMACOS.

José Manuel Ríos Yuil; Manuel Ríos Castro

Enviado octubre 20, 2024

Publicado 2026-03-02

Artículos de Investigación

Vol. 24 Núm. 1 (2011): Revista Médico Científica

EL CONCEPTO P-I: UNA NUEVA TEORÍA INMUNOLÓGICA SOBRE LAS REACCIONES CUTÁNEAS ASOCIADAS A FÁRMACOS.

José Manuel Ríos Yuil ⁺⁻
Manuel Ríos Castro⁺⁻

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DOI: ND

Publicado: 2026-03-02

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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.

Resumen

Las reacciones de hipersensibilidad a fa?rmacos con repercusio?n cuta?nea cada vez son ma?s frecuentes. Su severidad vari?a desde reacciones relativamente leves hasta aquellas que ponen en peligro la vida del paciente. El concepto p-i es una nueva hipo?tesis inmunolo?gica que sen?ala que ciertos medicamentos se pueden unir directamente, especi?ficamente y reversiblemente a algunos receptores de ce?lulas T. De esta manera, pueden generar una respuesta de hipersensibilidad sin necesidad de ser procesados por las ce?lulas presentadoras de anti?genos o de sensibilizacio?n previa. El concepto p-i no fue formulado para reemplazar a las hipo?tesis del hapteno y del prohapteno, sino para complementarlas. Nos permite explicar el mecanismo por el que ocurren las reacciones que inician poco tiempo despue?s de la primera administracio?n del medicamento y por que? algunas infecciones virales aumentan el riesgo de sufrir una reaccio?n de hipersensibilidad a fa?rmacos.

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Martin T, Li H. Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis. Chin Med J (Engl). 2008 Apr 20; 121(8): 756-61.
Hausmann O, Schnyder B, Pichler WJ. Drug hypersensitivity reactions involving skin. Handb Exp Pharmacol. 2010; (196): 29-55.
Segal AR, Doherty KM, Leggott J, Zlotoff B. Cutaneous reactions to drugs in children. Pediatrics. 2007 Oct; 120(4): e1082-96.
Roujeau JC. Clinical heterogeneity of drug hypersensitivity. Toxicology. 2005 Apr 15; 209(2): 123-9.
Shiohara T, Mizukawa Y. Fixed drug eruption: a disease mediated by self-inflicted responses of intraepidermal T cells. Eur J Dermatol. 2007 May-Jun; 17(3): 201-8.
Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. 2007 Jun; 49(2): 89-106.
Hammerbeck AA, Daniels NH, Callen JP. Ioversol-induced acute generalized exanthematous pustulosis: a case report. Arch Dermatol. 2009 Jun; 145(6): 683-7.
Valeyrie-Allanore L, Roujeau JC. Denominations and classification of severe cutaneous adverse reactions to drugs: splitters versus mergers. Eur J Dermatol. 2007 Sep-Oct; 17(5): 359-60.
Shiohara T, Inaoka M, Kano Y. Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpes viruses and antiviral and antidrug immune responses. Allergol Int. 2006 Mar; 55(1): 1-8.
Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, et al. Stevens - Johnson syndrome and Toxic Epidermal Necrolysis: Assessment of Medication Risks with emphasis on recently marketed drugs. The EuroSCAR-Study. J Invest Dermatol. 2008 Jan; 128(1): 35-44.
French LE. Toxic epidermal necrolysis and Stevens Johnson Syndrome: Our current understanding. Allergol Int. 2006 Mar; 55(1): 9-16.
Prins C, Kerdel F, Padilla S, Hunziker T, Chimenti S, Viard I, et al. Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases. Arch Dermatol 2003; 139: 26-32.
García Doval I, Roujeau JC, Cruces Prado MJ. Necrolisis epidérmica tóxica y síndrome de Stevens-Johnson: clasificación y actualidad terapéutica. Actas Dermosifiliogr 2000; 91: 541-51.
Molgó M, Carreño N, Hoyos-Bachiloglu R, Andresen M, González S. Use of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis and Stevens-Johnson/toxic epidermal necrolysis overlap syndrome. Review of 15 cases. Rev Méd Chile 2009; 137: 383-9.
Gonzalo-Garijo MA, de Argila D. Erythroderma due to aztreonam and clindamycin. J Investig Allergol Clin Immunol. 2006; 16(3): 210-1.
Schnyder B, Pichler WJ. Mechanisms of drug-induced allergy. Mayo Clin Proc. 2009 Mar; 84(3): 268-72.
Pichler WJ. The p-i concept: pharmacological interaction of drugs with immune receptors. WAO Journal 2008; 1: 96-102.
Roychowdhury S, Svensson CK. Mechanisms of Drug-induced delayed-type hypersensitivity reactions in the skin. AAPS J. 2005 Dec 9; 7(4): E834-46.
Pichler WJ, Beeler A, Keller M, Lerch M, Posadas S, Schmid D, et al. Pharmacological interaction of drugs with immune receptors: the p-i concept. Allergol Int. 2006 Mar; 55(1): 17-25.
Gerber BO, Pichler WJ. Noncovalent interactions of drugs with immune receptors may mediate drug-induced hypersensitivity reactions. AAPS J. 2006 Mar 17; 8(1): E160-5.
Pichler WJ (ed): Drug hypersensitivity reactions: classification and relationship to T-cell activation. Basel, Karger, 2007, pp 168-189.
Roujeau JC. Immune mechanisms in drug allergy. Allergol Int. 2006 Mar; 55(1): 27-33.
Tohkin M, Ishiguro A, Kaniwa N, Saito Y, Kurose K, Hasegawa R. Prediction of severe adverse drug reactions using pharmacogenetic biomarkers. Drug Metab Pharmacokinet. 2010; 25(2): 122-33.

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[1] Martin T, Li H. Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis. Chin Med J (Engl). 2008 Apr 20; 121(8): 756-61.

[2] Hausmann O, Schnyder B, Pichler WJ. Drug hypersensitivity reactions involving skin. Handb Exp Pharmacol. 2010; (196): 29-55.

[3] Segal AR, Doherty KM, Leggott J, Zlotoff B. Cutaneous reactions to drugs in children. Pediatrics. 2007 Oct; 120(4): e1082-96.

[4] Roujeau JC. Clinical heterogeneity of drug hypersensitivity. Toxicology. 2005 Apr 15; 209(2): 123-9.

[5] Shiohara T, Mizukawa Y. Fixed drug eruption: a disease mediated by self-inflicted responses of intraepidermal T cells. Eur J Dermatol. 2007 May-Jun; 17(3): 201-8.

[6] Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. 2007 Jun; 49(2): 89-106.

[7] Hammerbeck AA, Daniels NH, Callen JP. Ioversol-induced acute generalized exanthematous pustulosis: a case report. Arch Dermatol. 2009 Jun; 145(6): 683-7.

[8] Valeyrie-Allanore L, Roujeau JC. Denominations and classification of severe cutaneous adverse reactions to drugs: splitters versus mergers. Eur J Dermatol. 2007 Sep-Oct; 17(5): 359-60.

[9] Shiohara T, Inaoka M, Kano Y. Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpes viruses and antiviral and antidrug immune responses. Allergol Int. 2006 Mar; 55(1): 1-8.

[10] Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, et al. Stevens - Johnson syndrome and Toxic Epidermal Necrolysis: Assessment of Medication Risks with emphasis on recently marketed drugs. The EuroSCAR-Study. J Invest Dermatol. 2008 Jan; 128(1): 35-44.

[11] French LE. Toxic epidermal necrolysis and Stevens Johnson Syndrome: Our current understanding. Allergol Int. 2006 Mar; 55(1): 9-16.

[12] Prins C, Kerdel F, Padilla S, Hunziker T, Chimenti S, Viard I, et al. Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases. Arch Dermatol 2003; 139: 26-32.

[13] García Doval I, Roujeau JC, Cruces Prado MJ. Necrolisis epidérmica tóxica y síndrome de Stevens-Johnson: clasificación y actualidad terapéutica. Actas Dermosifiliogr 2000; 91: 541-51.

[14] Molgó M, Carreño N, Hoyos-Bachiloglu R, Andresen M, González S. Use of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis and Stevens-Johnson/toxic epidermal necrolysis overlap syndrome. Review of 15 cases. Rev Méd Chile 2009; 137: 383-9.

[15] Gonzalo-Garijo MA, de Argila D. Erythroderma due to aztreonam and clindamycin. J Investig Allergol Clin Immunol. 2006; 16(3): 210-1.

[16] Schnyder B, Pichler WJ. Mechanisms of drug-induced allergy. Mayo Clin Proc. 2009 Mar; 84(3): 268-72.

[17] Pichler WJ. The p-i concept: pharmacological interaction of drugs with immune receptors. WAO Journal 2008; 1: 96-102.

[18] Roychowdhury S, Svensson CK. Mechanisms of Drug-induced delayed-type hypersensitivity reactions in the skin. AAPS J. 2005 Dec 9; 7(4): E834-46.

[19] Pichler WJ, Beeler A, Keller M, Lerch M, Posadas S, Schmid D, et al. Pharmacological interaction of drugs with immune receptors: the p-i concept. Allergol Int. 2006 Mar; 55(1): 17-25.

[20] Gerber BO, Pichler WJ. Noncovalent interactions of drugs with immune receptors may mediate drug-induced hypersensitivity reactions. AAPS J. 2006 Mar 17; 8(1): E160-5.

[21] Pichler WJ (ed): Drug hypersensitivity reactions: classification and relationship to T-cell activation. Basel, Karger, 2007, pp 168-189.

[22] Roujeau JC. Immune mechanisms in drug allergy. Allergol Int. 2006 Mar; 55(1): 27-33.

[23] Tohkin M, Ishiguro A, Kaniwa N, Saito Y, Kurose K, Hasegawa R. Prediction of severe adverse drug reactions using pharmacogenetic biomarkers. Drug Metab Pharmacokinet. 2010; 25(2): 122-33.

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