Drug reaction with eosinophilia and systemic symptoms (DRESS): An original multisystem adverse drug reaction. Results from the prospective RegiSCAR study
Journal
British Journal of Dermatology
Journal Volume
169
Journal Issue
5
Pages
1071-1080
Date Issued
2013
Author(s)
Kardaun S.H.
Sekula P.
Valeyrie-Allanore L.
Liss Y.
Creamer D.
Sidoroff A.
Naldi L.
Mockenhaupt M.
Roujeau J.C.
Abstract
Background Cases of severe drug hypersensitivity, demonstrating a variable spectrum of cutaneous and systemic involvement, are reported under various names, especially drug reaction with eosinophilia and systemic symptoms (DRESS). Case definition and overlap with other severe cutaneous adverse reactions (SCAR) are debated. Objectives To analyse the spectrum of signs and symptoms of DRESS and distribution of causative drugs in a large multicentre series. Patients and methods RegiSCAR, a multinational registry of SCAR, prospectively enrolled 201 potential cases from 2003 to mid-2009. Using a standardized scoring system, 117 cases were validated as showing probable or definite DRESS. Results The male/female ratio was 0·80; females were borderline significantly younger than males. Next to the ubiquitous exanthema, the main features were eosinophilia (95%), visceral involvement (91%), high fever (90%), atypical lymphocytes (67%), mild mucosal involvement (56%) and lymphadenopathy (54%). The reaction was protracted in all but two patients; two patients died during the acute phase. Drug causality was plausible in 88% of cases. Antiepileptic drugs were involved in 35%, allopurinol in 18%, antimicrobial sulfonamides and dapsone in 12% and other antibiotics in 11%. The median time interval after drug intake was 22 days (interquartile range 17-31) for all drugs with (very) probable causality, with differences between drugs. Conclusion This prospective observational study supports the hypothesis that DRESS is an original phenotype among SCAR in terms of clinical and biological characteristics, causative drugs, and time relation. The diversity of causative drugs was rather limited, and mortality was lower than that suggested by prior publications. What's already known about this topic? DRESS is a hypersensitivity reaction, characterized by a variable combination of symptomatic and asymptomatic features. What does this study add? DRESS is an original phenotype among severe cutaneous adverse reactions in terms of clinical and biological characteristics, drugs, time relation, and course. Besides eosinophilia, other haematological abnormalities are frequent. The diversity of causative drugs is rather limited. The prodromal period is quite variable, introducing risk of protopathic bias, especially for antibiotics and NSAIDs. ? 2013 British Association of Dermatologists.
SDGs
Other Subjects
allopurinol; amoxicillin; antibiotic agent; anticonvulsive agent; carbamazepine; corticosteroid; cotrimoxazole; dapsone; dexamethasone; fluindione; lamotrigine; minocycline; oxcarbazepine; phenobarbital; phenytoin; salazosulfapyridine; sulfadiazine; sulfonamide; sultamicillin; vancomycin; adult; aged; article; blister; clinical article; comorbidity; disease registry; DRESS syndrome; drug eruption; drug exposure; drug fatality; drug safety; dysphagia; eczema; eosinophilia; epilepsy; erythroderma; eye disease; face edema; female; fever; genital system disease; gout; heart disease; human; Human herpesvirus 6; Human immunodeficiency virus infection; hyperuricemia; immunocompromised patient; kidney disease; leukocytosis; lichenoid; lip disease; liver disease; lung disease; lymphadenopathy; lymphocyte; lymphocytopenia; lymphocytosis; maculopapular rash; male; medication compliance; monocytosis; mood disorder; mouth disease; mouth lesion; mucosal dryness; muscle disease; neutrophilia; observational study; organ injury; outcome assessment; pain; pancreas disease; pharmacoepidemiology; photography; polypharmacy; priority journal; prospective study; pruritus; purpura; pustule; rash; scoring system; seizure; sex ratio; side effect; skin pain; spleen disease; systemic therapy; throat disease; thrombocytopenia; thrombocytosis; ubiquitous exanthema; unspecified side effect; urticaria; Adult; Aged; Drug Eruptions; Drug Hypersensitivity Syndrome; Female; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Registries
Type
journal article