Photopheresis; the risk of photoallergy.

Photopheresis is a therapy for several T-cell-mediated disorders, aiming at a specific immune response against the pathogenic clone of T cells involved. With photopheresis, a mixture of patients' buffy coat and plasma, which contains 8-methoxypsoralen (8-MOP), is diluted with phosphate-buffered saline (PBS) and exposed to ultraviolet A radiation (UVA). After the irradiation the treated fraction is reinfused. As photomodification of biomacromolecules is considered to be crucial in photopheresis, the presence of plasma during irradiation can pose a problem. The fact is that photomodification of plasma proteins is supposed to be the causal step in the occurrence of photoallergy. Whether the presence of plasma during photopheresis is a risk for photoallergy was investigated with 8-MOP and chlorpromazine (CPZ; well-established photoallergen). It proved that both sensitizers can induce photoallergy, although the concentration of 8-MOP needed to induce photoallergy is 4.5 times higher than that of CPZ. It is concluded that the presence of plasma during irradiation should be avoided in order to prevent the risk of induction of photoallergy.