Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) / Drug-induced Hypersensitivity Syndrome (DIHS): a review of current concepts

The Drug Reaction with Eosinophilia and Systemic Symptoms syndrome, also known as Drug Induced Hypersensitivity Syndrome presents clinically as an extensive mucocutaneous rash, accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas. Recognition of this syndrome is of paramount importance, since the mortality rate is about 10% to 20%, and a specific therapy may be necessary. The pathogenesis is related to specific drugs, especially the aromatic anticonvulsants, altered immune response, sequential reactivation of herpes virus and association with HLA alleles. Early recognition of the syndrome and withdrawal of the offending drug are the most important and essential steps in the treatment of affected patients. Corticosteroids are the basis of the treatment of the syndrome, which may be associated with intravenous immunoglobulin and, in selected cases, Ganciclovir. The article reviews the current concepts involving this important manifestation of adverse drug reaction.

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Recent Advances in Drug-Induced Hypersensitivity Syndrome/Drug Reaction with Eosinophilia and Systemic Symptoms

Journal of Immunology Research ◽

10.1155/2018/5163129 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 21

Author(s):

Hideaki Watanabe

Keyword(s):

Drug Reaction ◽

T Cell Activation ◽

Early Recognition ◽

Early Stage ◽

Disease Process ◽

Systemic Reaction ◽

Hypersensitivity Syndrome ◽

Published Data ◽

Drug Induced ◽

Systemic Symptoms

Drug-induced hypersensitivity syndrome (DIHS), also termed as drug reaction with eosinophilia and systemic symptoms (DRESS), is a multiorgan systemic reaction characterized by a close relationship with the reactivation of herpes virus. Published data has demonstrated that among patients with DIHS/DRESS, 75–95% have leukocytosis, 18.2–90% show atypical lymphocytes, 52–95% have eosinophilia, and 75–100% have hepatic abnormalities. Histologically, eosinophils were observed less frequently than we expected (20%). The mainstay of DIHS/DRESS treatment is a moderate dose of systemic corticosteroids, followed by gradual dose reduction. In this review, we will emphasize that elevations in the levels of several cytokines/chemokines, including tumor necrosis factor- (TNF-) α and the thymus and activation-regulated chemokine (TARC/CCL17), during the early stage of disease, are good markers allowing the early recognition of HHV-6 reactivation. TNF-α and TARC levels also reflect therapeutic responses and may be useful markers of the DIHS disease process. Recently, the pathogenic mechanism of T-cell activation triggered by human leukocyte antigen- (HLA-) restricted presentation of a drug or metabolites was elucidated. Additionally, we recently reported that dapsone would fit within the unique subpocket of the antigen-recognition site of HLA-B∗13:01. Further studies will render it possible to choose better strategies for DIHS prevention and therapy.

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Faculty Opinions recommendation of Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725328660.793504301 ◽

2015 ◽

Author(s):

Rannakoe Lehloenya

Keyword(s):

Drug Reaction ◽

Adverse Reactions ◽

Hypersensitivity Syndrome ◽

Research Committee ◽

Drug Induced ◽

Severe Cutaneous Adverse Reactions ◽

Systemic Symptoms ◽

Cutaneous Adverse Reactions

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Severe drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms in a 1‐month‐old infant with trisomy 21

The Journal of Dermatology ◽

10.1111/1346-8138.16042 ◽

2021 ◽

Author(s):

Asami Osada ◽

Takeshi Arimitsu ◽

Hisataka Nakazaki ◽

Takane Kin ◽

Sachiko Kaburagi ◽

...

Keyword(s):

Drug Reaction ◽

Trisomy 21 ◽

Hypersensitivity Syndrome ◽

Drug Induced ◽

Systemic Symptoms

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Successful mepolizumab treatment for DRESS-induced refractory eosinophilic myocarditis and concurrent thyroiditis

BMJ Case Reports ◽

10.1136/bcr-2021-242240 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242240

Author(s):

Kelvin Truong ◽

Shane Kelly ◽

Angela Bayly ◽

Annika Smith

Keyword(s):

Adverse Drug Reaction ◽

Clinical Trials ◽

Drug Reaction ◽

Mortality Rate ◽

Prospective Studies ◽

High Quality ◽

Unique Case ◽

Life Threatening ◽

Eosinophilic Myocarditis ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction with a mortality rate of 10%. Interstitial nephritis, pneumonitis, myocarditis, meningitis, thyroiditis and pancreatitis are major causes of morbidity and mortality in this syndrome. Cessation of offending medication is paramount. There is paucity in high quality prospective studies guiding the treatment of DRESS, and there are no published therapeutic clinical trials in the treatment of corticosteroid refractory hypersensitivity myocarditis. The authors present a unique case of ciprofloxacin-induced DRESS with concurrent thyroiditis and refractory eosinophilic myocarditis that required mepolizumab and multiple immunosuppressants for successful treatment.

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