Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Diagnosis and Management of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS)
abstract
This abstract is available on the publisher's site.
Access this abstract nowDrug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, adverse drug reaction that is notoriously complex in both its presentation and treatment. Although early diagnosis and cessation of the causative agent are universally accepted as the initial interventions for DRESS, the subsequent management lacks a standardized approach. Historically, systemic steroids have been used as first-line treatment, but there is debate about the optimal dosing and route of administration, and evidence persists on the long-term complications associated with steroid use. Novel treatment approaches with targeted therapy, cyclosporine, intravenous immunoglobulin, and plasmapheresis have been gaining interest as alternative mono- and adjuvant therapies, but their use has yet to be supported by clinical trials. This narrative review provides a summary of the current knowledge of DRESS, with a focus on clinical management. The various mono- and adjuvant therapy options are discussed, with literature-supported suggestions for their optimal use in clinical practice. The risks for relapses, viral reactivation, and long-term complications are also considered. The PubMed and Medline databases were searched for articles on DRESS, published between January 1, 2008, and May 1, 2023. 334 articles met the inclusion criteria. Based on the literature, a DRESS management tool with step-by-step guidance is provided. Further suggestions for management are woven throughout this review, giving clinicians a toolbelt of resources with which to approach diagnosis, treatment, and follow-up.
Additional Info
Demystifying drug reaction with eosinophilia and systemic symptoms (DRESS): a review of the literature and guidelines for management
Arch Dermatol Res 2024 Sep 26;316(9)644, CL WedelFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome is a serious drug reaction that occurs in 1 in 1000 to 1 in 10,000 drug exposures and is associated with a mortality rate of approximately 10%. The most common medications associated with DRESS are aromatic anticonvulsants, allopurinol, sulfonamides, proton pump inhibitors, and antibiotics. The clinical presentation of DRESS includes high fever (often >38 °C), rash (with variable presentations, but most often widespread), characteristic facial edema, lymphadenopathy, organ involvement, and hematologic abnormalities (including, but not requiring, eosinophilia). Viral reactivation with cytomegalovirus can occur and can lead to further complications.
This article is a literature review that included publications regarding DRESS occurring in adults from 2008 to 2023, with a special focus on treatment, including a suggested management algorithm. In the management algorithm, a branch point of organ involvement is highlighted, with patients without organ involvement or only mild involvement recommended to undergo monitoring and management with topical steroids. For patients with significant organ involvement, systemic steroids are recommended as the first-line treatment, with a slow (over 3–6 months) taper. For patients with contraindications to systemic steroids or those without sufficient response, alternative agents are suggested, with the most evidence for cyclosporine at a dose of 1.73 to 5 mg/kg/day and intravenous immunoglobulin, with intravenous immunoglobulin primarily used as an adjuvant therapy with systemic steroids. Lastly, recommendations are made regarding the use of antiviral therapy if cytomegalovirus reactivation is suspected as well as long-term monitoring for late autoimmune sequelae such as thyroiditis.