Intravenous immunoglobulin in the treatment of drug rash eosinophilia and systemic symptoms caused by phenytoin

Santhamoorthy, Ponnusamy; Alexander, K J; Al-Shubaili, Asmahan

doi:10.4103/0972-2327.104348

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…12 IVIG has been successfully combined with corticosteroids and may have a role in cases refractory to systemic steroid administration. 3,7,8 Drug reaction with eosinophilia and systemic symptoms syndrome is thought to be a T cell-mediated reaction related to human leukocyte antigen (HLA) type and racial factors. 13 It is hypothesized to occur in individuals with drug detoxification defects that lead to an increase in reactive metabolites and subsequent immunologic reaction coupled with reactivation of specific viruses such as HHV-6.…”

Section: Discussionmentioning

confidence: 99%

“…Although the benefits of IVIG treatment in severe adverse drug reactions have not been completely Despite the potential benefits of IVIG, its effectiveness as an adjunct to systemic corticosteroids in steroid hyporesponsive DRESS syndrome remains unclear. Although IVIG has been successfully used to treat adults, 3,5,7,8 in one recent study, most patients suffered severe adverse effects. 9 However, a recent pediatric study showed minimal adverse effects of IVIG.…”

Section: Discussionmentioning

confidence: 99%

“…6 Some adult patients with DRESS syndrome have also been administered IVIG in addition to systemic corticosteroids for steroid hyporesponsive DRESS syndrome. 3,5,7,8 However, IVIG treatment in adults with DRESS syndrome is controversial; in a study of six patients with DRESS syndrome treated with IVIG, five experienced severe adverse effects. 9 The aim of the present study was to describe a series of adult patients who were diagnosed with DRESS syndrome, hyporesponsive to systemic steroids, and successfully treated with IVIG.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome

Sim

Koh

2021

Clinical Translational Sci

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially life-threatening, delayed, drug-induced hypersensitivity reaction. Immediate withdrawal of the culprit drug and administration of systemic corticosteroids is the most widely accepted treatment. However, it is difficult to manage patients with DRESS syndrome who are not responsive to systemic steroids. We studied the efficacy of intravenous immunoglobulins (IVIGs) in patients with DRESS syndrome unresponsive to systemic steroids. We retrospectively reviewed patients with DRESS syndrome who received IVIG in addition to systemic steroids during 2012-2017 and compared the clinical features and course of DRESS syndrome, before and after IVIG treatment. Eighteen DRESS patients (9 men) were included. The most frequent offending drugs were dapsone in five patients, followed by vancomycin in three patients, and carbamazepine in three patients. Rash, fever, lymphadenopathy, atypical lymphocytes, and hepatic involvement were common clinical findings. IVIG treatment was added within a median time of 7 days from the commencement of systemic steroid therapy. After IVIG treatment (total dosage: 1-2 g/kg), the fever resolved within a median time of 1 day (range, 0-3) and liver enzymes improved substantially within a median time of 13 days (range, 0-27). No severe adverse reactions related to IVIG therapy were observed in this study; however, there was one case of mortality. The addition of IVIG in DRESS syndrome in cases refractory to systemic steroid treatment may be helpful in hastening recovery. However, comparative studies using a placebo group are needed. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe delayed drug reaction. The main treatment is administration of systemic steroids. However, treatment of steroid hyporesponsive adults is unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome

Sim

Koh

2021

Clinical Translational Sci

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“…Our patient experienced mild DRESS syndrome, therefore resolution of signs and symptoms could not be ascribed to prednisone without reserve. High-dose intravenous immunoglobulin therapy has been established by various experts in USA as the first line treatment of DRESS syndrome and Toxic epidermal necrolysis based on findings that intravenous immunoglobulins can reduce Fas-FasL interaction [15,16].…”

Section: Discussionmentioning

confidence: 99%

DRESS syndrome without eosinophilia induced by Carbamazepine: A case report

Janković¹,

Jovicić²,

Pavlović³

et al. 2021

Hosp Pharm Int Multi J

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Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, severe, systemic, drug-induced hypersensitivity syndrome, the most frequently associated with anticonvulsants. Case Report: A 35-years-old woman with a history of depression and hypothyroidism developed fever 39.5°C, enlarged, painful neck and axillary lymph nodes, slight facial edema around the mouth, confluent maculopapular rash, and laboratory signs of hepatocellular injury, leukocytosis and lymphopenia, but with normal eosinophil count. The syndrome was evident two weeks after starting carbamazepine, and gradually decreased after withdrawal of this drug and introduction of corticosteroid therapy. Conclusion: If a patient is taking carbamazepine and develops skin rash as well as fever and swollen lymph nodes, the physician should always check for internal organ damage and possible DRESS syndrome.

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Severe Cutaneous Adverse Reactions to Drugs

Walsh

Lee

Creamer

2016

Rook's Textbook of Dermatology, Ninth Edition

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Severe life‐threatening cutaneous drug reactions are rare phenomena, and may be clinically heterogeneous. They may be broadly categorized as Stevens–Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis and drug‐induced generalized exfoliative dermatitis. Each has distinct clinical features, and is associated with systemic disturbance. Overlap syndromes with clinical features of more than one diagnosis are described.

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Intravenous immunoglobulin in the treatment of drug rash eosinophilia and systemic symptoms caused by phenytoin

Cited by 9 publications

References 12 publications

Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome

Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome

DRESS syndrome without eosinophilia induced by Carbamazepine: A case report

Severe Cutaneous Adverse Reactions to Drugs

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