Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature

Kim, Grace Y.; Anderson, Katelyn R.; Davis, Dawn M.; Hand, Jennifer L.; Tollefson, Megha M.

doi:10.1016/j.jaad.2020.03.081

Cited by 46 publications

(97 citation statements)

References 73 publications

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“…Neuropsychiatric disorders were the most common comorbidities found among included patients. This is consistent with antiepileptics being the main trigger of pediatric DRESS which is also in line with the results of a recent systematic review on pediatric DRESS by Kim et al 9 In fact, aromatic anticonvulsants, such as phenytoin, carbamazepine, and lamotrigine, activate the immune system by activating drug-specific T cells which secrete interleukin-5, interferon-gamma, and other cytokines. 1 48% of patients had no comorbidities.…”

Section: Pediatric Dresssupporting

confidence: 91%

“…c Interstitial pneumonitis and pleural effusion. Possible contributing factors in pediatric DRESS include infection with HHV-6, which was positive in 46% of tested pediatric patients and in 33% according to Kim et al, 9 whereas almost 80% of tested adult patients were positive. 3 The severity of DRESS depends particularly on internal organ involvement.…”

Section: Pediatric Dressmentioning

confidence: 90%

“…Our results are consistent with recently published systematic reviews on pediatric DRESS concerning the severity of the disease and its management. 9,10 However, DRESS often has a long course characterized by multiple episodes of complete or partial relapses or flares, despite withdrawing the culprit drug. 2,11,12 Reactivation of cutaneous symptoms during the first months following DRESS episode often occurs in a less severe form and in a shorter delay following drug exposure.…”

Section: Relapsing Pediatric Dressmentioning

confidence: 99%

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Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature, with a focus on relapsing cases

Afiouni

Zeinaty

Kechichian

et al. 2020

Pediatric Dermatology

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Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction with systemic symptoms. This study aims to investigate clinical features, causative drugs, and available treatments for pediatric DRESS, particularly for relapsing cases. Methods: A systematic search of the English and French literature on pediatric DRESS was conducted using the Medline, Embase, and Cochrane collaboration databases. Confirmed cases of pediatric DRESS fulfilling the RegiSCAR diagnostic criteria with a probable or a definite diagnosis were included. Results: After full-text article review, 144 articles were included, representing a total of 354 pediatric patients with a mean age of 8.8 years. The mean time from the drug intake until the onset of the first symptom was 18.9 days. Antiepileptic drugs were the main trigger, followed by anti-infectious agents. Relapsing DRESS was reported in 17 children. In comparison to non-relapsing cases, relapsing patients had more comorbidities. The initial clinical presentation was more commonly erythroderma. Facial edema, fever, and enlarged lymph nodes in more than two sites were more commonly found in relapsing cases. Systemic steroids were more frequently administered. Conclusion: Pediatric DRESS is a potentially severe adverse drug reaction. Antiepileptic agents are the most common causative agents. Fever, facial edema, lymph node enlargement, and pharyngeal and visceral involvement predicted DRESS reactivation in children. Corticosteroids were the mainstay of treatment.

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Section: Pediatric Dresssupporting

confidence: 91%

Section: Pediatric Dressmentioning

confidence: 90%

Section: Relapsing Pediatric Dressmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature, with a focus on relapsing cases

Afiouni

Zeinaty

Kechichian

et al. 2020

Pediatric Dermatology

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“…When MAS occurred during drug treatment, eosinophilia typically preceded this by months, consistent with evolution of DRESS-associated features. 2,20 Additional clinical details, including selected information about DLD subjects, are in figure 2 and tables S1, S2 .…”

Section: Resultsmentioning

confidence: 99%

Hypersensitivity reactions to IL-1 and IL-6 inhibitors are linked to common HLA-DRB1*15 alleles

Hollenbach

Ombrello

Tremoulet

et al. 2020

Preprint

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In Saper et al (2019), we described systemic JIA patients who developed a high-fatality diffuse lung disease (DLD) while on IL-1 or IL-6 inhibitors. We observed severe delayed drug hypersensitivity reactions (DHR) in a significant subset. Because alleles of the human leukocyte antigen (HLA) loci can mediate DHR, we investigated HLA genotype association with these DHR. We typed subjects treated with these inhibitors: 34 sJIA/DHR/DLD, 11 sJIA/DHR without DLD, 18 drug-tolerant sJIA, and 19 Kawasaki disease (KD) patients in an anti-IL-1(anakinra) trial. We also accessed genotypes from a large sJIA case/control cohort. We first compared White subjects with sJIA/DHR to 550 ancestry-matched sJIA subjects. We found striking enrichments of HLA-DRB1*15:01, HLA-DQA1*01:02, and DQB1*06:02, alleles in near-complete linkage (White individuals). HLA-DRB1*15:01 (as haplotype proxy) was increased in White sJIA subjects with DHR/DLD versus sJIA drug-tolerant controls and was observed upon inclusion of sJIA+DHR-only and KD+DHR White subjects. In our entire cohort regardless of ancestry, 75% carried HLA-DRB1*15:01 or the structurally related DRB1*15:03 and DRB1*15:06, which were absent among drug-tolerant subjects (p=5 x 10-13; Odds Ratio lower bound=20.11). Patients who harbor HLA-DRB1*15 alleles are at high risk of developing DHR to anti-IL-1/IL-6. Our data also suggest DHR maybe a trigger/enhancer of DLD in sJIA patients and support performing prospective HLA screening in sJIA, its adult-onset counterpart, and other inflammatory conditions where these drugs are used, such as KD.

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“…Existen sistemas nacionales e internacionales que registran esas reacciones adversas; en México el Centro Nacional de Farmacovigilancia, que forma parte de la COFEPRIS desde el año 2001, es el responsable de recibir los informes de la detección de sospechas de reacciones adversas a los medicamentos, vacunas y dispositivos médicos por parte de los profesionales de la salud y laboratorios productores, evaluarlas, valorarlas y retroalimentar la información. 8 Recientemente, Kim y colaboradores 9 realizaron una revisión sistemática de reacciones a medicamentos con presencia de eosinofilia y síntomas sistémicos, reportaron que más de 97% de los pacientes habían experimentado salpullido en la piel e identificaron al hígado como el segundo órgano más afectado. No obstante, esta revisión se enfoca sólo en lo reportado en población menor a 18 años, y a pesar del potencial letal que representan los eventos adversos (EA) medicamentosos, existe poca información actualizada que describa su frecuencia y comportamiento en población adulta mexicana.…”

Section: Introductionunclassified

Características epidemiológicas de farmacodermias en un hospital privado

Ordaz¹,

Zenteno²,

Greene³

et al. 2021

Acta Médica Grupo Ángeles

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Síganos en Twitter: @actaMHA ResumenIntroducción: Las farmacodermias representan un problema de salud, con incidencia anual en aumento debido a la automedicación y polifarmacia. Las reacciones cutáneas presentan grados de severidad y a pesar de representar un riesgo sanitario latente, existe poca información en la población mexicana, lo que hace necesaria su caracterización epidemiológica. Material y métodos: Estudio observacional, descriptivo, retrospectivo y transversal. Se incluyeron a pacientes hospitalizados en el Hospital Ángeles Pedregal, mayores de 15 años, con sospecha de efectos adversos a fármacos sistémicos con manifestaciones mucocutáneas, en un periodo comprendido de enero de 2016 a diciembre de 2018. Resultados: Se estudiaron 35,592 individuos, se identificó una incidencia acumulada de 5.28/1,000 pacientes hospitalizados, con predominio del sexo femenino (63%), edad promedio de 49.1 (± 17) años. El síntoma más frecuente fue prurito, asociado con exantema maculopapular, angioedema, urticaria y choque anafiláctico. Los fármacos involucrados en primer lugar fueron los antibióticos. Conclusiones: Los resultados concuerdan con la literatura internacional, señalando los antibióticos, especialmente las cefalosporinas y fluoroquinolonas, como parte de los fármacos más frecuentemente asociados con farmacodermias. La incidencia de estas manifestaciones alcanzó hasta 0.49% de la población hospitalizada y uno de cada 62 pacientes padecerán de una reacción medicamentosa que ponga en riesgo la vida.

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Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature

Cited by 46 publications

References 73 publications

Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature, with a focus on relapsing cases

Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature, with a focus on relapsing cases

Hypersensitivity reactions to IL-1 and IL-6 inhibitors are linked to common HLA-DRB1*15 alleles

Características epidemiológicas de farmacodermias en un hospital privado

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