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

Abstract

<jats:p>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.</jats:p>

Reacción por drogas con eosinofilia y síntomas sistémicos (síndrome de DRESS): Estudio retrospectivo de nueve casos

“…También se debe realizar un ultrasonido renal y un examen general de orina. Normalmente estas alteraciones desaparecen al retirar el fármaco causante, pero en algunos casos puede evolucionar hasta causar una nefritis intersticial 15 . En este estudio, la afectación renal con elevaciones de la urea y la creatinina sérica, proteinuria y hematuria, se observó en 11,1% de los pacientes.…”

Allergy to Antibiotics in Children: Who Is to Blame and What to Do?

“…The severest and most serious in terms of patients' life and health prognosis hypersensitivity reactions to antibiotics are severe skin allergic reactions (Stevens-Johnson and Lyell's syndromes) and drug-induced hypersensitivity syndrome (or drug-induced eosinophilia with systemic symptoms). Drug-induced hypersensitivity syndrome cannot be considered a widespread manifestation of drug allergy, although severity of clinical manifestations and potentially severe consequences substantiate necessity of describing this syndrome [49,50]. Thus, drug-induced hyperreactivity syndrome-associated mortality is ca.…”

“…Term "drug-induced hypersensitivity syndrome" (DIHS) is synonymous to terms "drug reaction and eosinophilia with systemic symptoms" (DRESS) and "drug hypersensitivity syndrome" [49]. Typical manifestations and symptoms include macular (spotty) exanthema, fever, weakness, edema of lymph nodes and involvement of various organs and systems (hepatitis -50%, nephritis -10%; pneumonitis, colitis and pancreatitis are observed less frequently) [49][50][51]. DRESS is often induced by tetracyclines and is most often clinically manifested with lymphadenopathy.…”

DRESS Syndrome After Phenytoin Use: A Case Report

“…DRESS Sendromunun yaklaşık mortalite oranı %10'dur. 4,5 Tedavide temel prensip hızlı tanı, neden olan ilaç veya ilaçları hemen kesmek, kortikosteroid ve destek tedavisi başlamaktır. 5 Bu çalışmada subdural hematom drenajı sonrasında fenitoin kullanımına bağlı gelişen DRESS Sendromunun klinik özellikleri, tedavi yaklaşımı ve prognozu sunulmuştur.…”