Abstract:
During medical training all doctors are taught the importance of the cytochrome P450 (CYP) system and the
detoxification functions of the liver. An important challenge for pharmaceutical companies is launching new
pharmaceutical entities that have an acceptable safety profile and this usually entails finding molecules with a limited
effect on the CYP system. Biotransformation seems to be a novel concept in allergy and immunology but ironically
it has been used extensively in the medical field over many decades. This article is aimed at providing a differential
diagnosis to those patients that do not quite fit the allergic picture/profile, using the concept of biotransformation
to analyse them and ideally find a new solution to their disease profile. Examples of these extraordinary patients
include those with numerous drug reactions but with no common ‘allergic’ trigger, recurring upper airway
infections or chronic otitis media and common variable immunodeficiency, difficult to control asthmatics with
concomitant inflammatory diseases like ulcerative colitis and the ‘allergic’ rhinitic with no obvious causative allergen.
