Predictors of disease severity in drug reaction with eosinophilia and systemic symptoms

Abstract

Studies on the predictors of severity in drug reaction with eosinophilia and systemic symptoms in different population groups may enable us to identify the warning signs and help to formulate the standard therapeutic guidelines.

Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study

“…Though, two of the patients denied any history of prior exposure, it is possible that same or a related drug may have been taken by the patient earlier. This rapid onset of symptoms on second exposure has been reported previously 10,12‐14 . Commonly reported culprit drugs were sulpha group (five with dapsone and two with Sulphasalazine) followed by aromatic AED (Phenytoin: five, Oxcarbazine:one).…”

“…However, this correlation did not reach statistical significance possibly due to a small sample size. Liver was the commonest internal organ affected in 14 (70%) patients with comparable frequency to study by Sasidharanpillai et al 10 But its involvement in DRESS has been reported more frequently in European and eastern countries 4,8,12 . The difference could be due to racial distribution and regional drug profile 19 .…”

“…A patient of HIV infection with CD4 count of 32 cells/μl did not develop fever, possibly because of poor immune response. Lymphadenopathy was present in 95% patients which was much higher than reported in literature 4,8,10‐12,15 …”

“…However, due to the limitation of the sample size in this study, it is difficult to stratify characteristic organ involvement in DRESS based on all the drugs here. Literature review states drug specific organ propensity with allopurinol having renal involvement, liver involvement with anti‐tubercular drugs, phenytoin, carbamazepine and lamotrigine, minocycline causing eosinophilic pneumopathy and cardiac involvement, dapsone with hepatic‐renal involvement, and gastrointestinal features with abacavir 4,5,10,15,20,21 …”

Drug reaction with eosinophilia and systemic symptoms within 1 week of exposure to the drug

“…2 A larger cross-sectional study that evaluated all patients with DRESS who were treated in our department since 2011 confirmed our earlier findings; in addition, we noted that the interval of less than 2 weeks between the beginning of drug intake and the appearance of symptoms was not unique to DRESS precipitated by antibiotics. 2,3 (We had included both probable and definite cases of DRESS, as per RegiSCAR (Registry of Severe Cutaneous Adverse Reaction) DRESS validation scoring system. )…”