Hypersensitivity to antibiotics in drug reaction with eosinophilia and systemic symptoms (DRESS) from other culprits

Santiago, Luís; Morgado, Francisca; Baptista, Mariana S.; Gonçalo, Margarida

doi:10.1111/cod.13462

Cited by 20 publications

(24 citation statements)

References 24 publications

(39 reference statements)

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“…Clinical entity characterized by high levels of eotaxin and IL‐5 in skin lesions (responsible for the recruitment of eosinophils), and by skin infiltration of CD4 + and CD8 + T cells 90 . A recently published work showed that if there is an exposure to antibiotics during the active phase of DRESS, it can trigger a sensitization to the administered drug; which is explained by the massive activation of reactive immune cells 91 . A later manuscript has shown that other drugs such as radiocontrast media, proton pumps inhibitors or analgesics could be also involved in DRESS relapses 46 …”

Section: Immunological Mechanisms In Dhrsmentioning

confidence: 99%

“…90 A recently published work showed that if there is an exposure to antibiotics during the active phase of DRESS, it can trigger a sensitization to the administered drug; which is explained by the massive activation of reactive immune cells. 91 A later manuscript has shown that other drugs such as radiocontrast media, proton pumps inhibitors or analgesics could be also involved in DRESS relapses. 46 These relapses may be associated with unknown mechanisms, and, in most cases, patients tolerate the drug after the complete recovery.…”

Section: Dressmentioning

confidence: 99%

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Advances and highlights in T and B cell responses to drug antigens

Fernandez

Ariza

Fernández

et al. 2021

Allergy

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The immunological mechanisms involved in drug hypersensitivity reactions (DHRs) are complex, and despite important advances, multiple aspects remain poorly understood. These not fully known aspects are mainly related to the factors that drive towards either a tolerant or a hypersensitivity response and specifically regarding the role of B and T cells. In this review, we focus on recent findings on this knowledge area within the last 2 years. We highlight new evidences of covalent and non‐covalent interactions of drug antigen with proteins, as well as the very first characterization of naturally processed flucloxacillin‐haptenated human leukocyte antigen (HLA) ligands. Moreover, we have analysed new insights into the identification of risk factors associated with the development of DHRs, such as the role of oxidative metabolism of drugs in the activation of the immune system and the discovery of new associations between DHRs and HLA variants. Finally, evidence of IgG‐mediated anaphylaxis in humans and the involvement of specific subpopulations of effector cells associated with different clinical entities are also topics explored in this review. All these recent findings are relevant for the underlying pathology mechanisms and advance the field towards a more precise diagnosis, management and treatment approach for DHRs.

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Section: Immunological Mechanisms In Dhrsmentioning

confidence: 99%

Section: Dressmentioning

confidence: 99%

Advances and highlights in T and B cell responses to drug antigens

Fernandez

Ariza

Fernández

et al. 2021

Allergy

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“…When evaluating drug allergy, not only the initial DRESS trigger should be considered, but also drugs that were administered during the active phase of DRESS, if involved in relapses. Santiago et al have recently shown that a large proportion of DRESS patients develop a new sensitization to antibiotics administered during DRESS [ 17 ]. Our data suggest that also other non-antibiotic drugs may cause relapses with detectable sensitization such as radio contrast agents, proton pump inhibitors and NSAID.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, some patients showed a new T cell sensitization to the causing drug, leading to a multiple drug hypersensitivity syndrome (MDH) [14–16 ]. These patients are at risk of developing a drug hypersensitivity on re‐exposure [17 ], therefore, they have to avoid multiple structurally different drugs. Thus, the distinction between drug‐related relapse without proven sensitization and MDH is pivotal for the subsequent therapeutic management.…”

Section: Introductionmentioning

confidence: 99%

Drug-related relapses in drug reaction with eosinophilia and systemic symptoms (DRESS)

Jörg

Helbling

Yerly

et al. 2020

Clin Transl Allergy

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Background A drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe T cell mediated hypersensitivity reaction. Relapses of symptoms in the recovery phase are frequent and linked to the reduction of the corticosteroid treatment, to viral reactivations or to the exposure to new drugs. Here, we analyzed, how often the exposure to new drugs leads to new sensitization or drug-related relapses without detectable sensitization. Methods 46 patients with DRESS treated in the allergy division of the Inselspital, Bern University Hospital, were retrospectively assessed. Drug-related relapses were analyzed in terms of frequency and whether a possible sensitization evaluated by skin tests and/or lymphocyte transformation tests (LTT) to the new drugs was detectable. Furthermore, drug tolerance was evaluated in a subset of patients. Results 56 relapses were observed in 27 of 46 patients with DRESS (58.7%). 33 (58.9%) of these relapses were associated with the use of new drugs, 30 drug-related relapses were evaluated by patch test and/or lymphocyte transformation test. In 8/30 (26.7%) drug-related relapses, a sensitization to the new drug was demonstrated, suggesting the emergence of a multiple drug hypersensitivity syndrome (MDH). 14 patients experienced 22 drug-related relapses without any detectable sensitization and only 1/6 patients developed new symptoms upon reexposure. Conclusion Patients with DRESS frequently suffered from drug related relapses. Half of the patients with drug-related relapses developed a MDH with proven sensitizations not only to the DRESS inducing drugs, but also to newly applied drugs. When not sensitized, drugs involved in drug related relapses could be reintroduced, if needed. Here, we propose a procedure for drug testing and future management of drug-related relapses in DRESS.

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“…For culprit drugs, the median time to onset was 22 days (IQR 17-28). Drugs involved are shown in Table S1 (Supporting Information), including allopurinol (25%, median time to onset 19 days, IQR 17-24), sulfasalazine (20%, median 24 days, IQR 19-24) and carbamazepine (20%, median 28 days, IQR [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Section: Case Characteristics In Each Onset Modalitymentioning

confidence: 99%

Specific features of amoxicillin‐associated Drug Reaction with Eosinophilia and Systemic Symptoms syndrome: a nationwide study

Largeau

Agier

Beau-Salinas

et al. 2021

Acad Dermatol Venereol

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Background Growing evidence indicates that amoxicillin induces herpesvirus replication in vitro. As these play a central pathophysiological role in Drug Reaction with Eosinophilia and Systemic Symptoms syndrome (DRESS), amoxicillin could present with specific DRESS features. Objective To characterize the onset patterns of amoxicillin‐associated DRESS. Methods All cases of DRESS (Kardaun score ≥4) involving amoxicillin and reported in the French Pharmacovigilance Database between January 1, 2004 and November 30, 2019 were included. Onset circumstances for these cases were categorized considering the onset delay from amoxicillin initiation, and the presence of concomitant medications with a compatible time to onset. Results A total of 146 probable cases or definite cases of DRESS were included. Three onset circumstances were identified: (i) ‘amoxicillin clear culprit’ where amoxicillin was the sole suspect drug or when concomitant drugs of compatible time to onset were not reported to cause DRESS (n = 62); (ii) ‘amoxicillin possible culprit’ in the presence of other potentially culprit drugs in addition to amoxicillin (n = 44) and (iii) ‘flare’ where amoxicillin, used after DRESS onset, induced flare‐up reactions (n = 40). The median time to onset was 5 days (IQR 2–11) in ‘clear culprit’, and 18 days (IQR 7–26) in ‘possible culprit’ cases. In ‘flare’ cases, the median latency between amoxicillin initiation and flare‐up reactions was 3 days (IQR 2–5). Conclusions Amoxicillin can induce DRESS with a specific early onset and exacerbate DRESS from another drug.

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Hypersensitivity to antibiotics in drug reaction with eosinophilia and systemic symptoms (DRESS) from other culprits

Cited by 20 publications

References 24 publications

Advances and highlights in T and B cell responses to drug antigens

Advances and highlights in T and B cell responses to drug antigens

Drug-related relapses in drug reaction with eosinophilia and systemic symptoms (DRESS)

Specific features of amoxicillin‐associated Drug Reaction with Eosinophilia and Systemic Symptoms syndrome: a nationwide study

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