From the Guidelines
DRESS syndrome is a severe, potentially life-threatening drug reaction that can occur as a side effect of certain medications, characterized by a widespread skin rash, fever, enlarged lymph nodes, and internal organ involvement, particularly the liver, and requires immediate discontinuation of the offending drug and often necessitates hospitalization for treatment.
Definition and Characteristics
DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. It typically develops 2-8 weeks after starting a new medication and involves an increase in a type of white blood cell called eosinophils.
Common Medications Associated with DRESS Syndrome
Common medications associated with DRESS syndrome include anticonvulsants, antibiotics, and allopurinol, as noted in studies such as 1 and 1.
Management and Treatment
Recognizing DRESS syndrome early is crucial for proper management and to prevent potentially severe complications. The management of DRESS syndrome involves the immediate discontinuation of the offending drug and supportive care, which may include hospitalization, as recommended in guidelines such as 1 and 1.
Key Considerations
It is essential to consider the risk of DRESS relapse when testing for drug allergies, and testing should be avoided until more than 6 months have elapsed from the acute reaction, as suggested in 1.
Importance of Early Recognition
Early recognition of DRESS syndrome is critical to prevent severe complications and improve patient outcomes, highlighting the need for healthcare providers to be aware of the signs and symptoms of this condition, as emphasized in studies such as 1 and 1. Some key points to consider in the management of DRESS syndrome include:
- Immediate discontinuation of the offending drug
- Hospitalization for supportive care and monitoring
- Avoidance of testing for drug allergies until more than 6 months have elapsed from the acute reaction
- Consideration of the risk of DRESS relapse when testing for drug allergies
- Importance of early recognition and prompt treatment to prevent severe complications and improve patient outcomes.
From the FDA Drug Label
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as multiorgan hypersensitivity, has occurred with carbamazepine. Some of these events have been fatal or life-threatening DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling, in association with other organ system involvement, such as hepatitis, nephritis, hematologic abnormalities, myocarditis, or myositis sometimes resembling an acute viral infection. Eosinophilia is often present
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a potentially life-threatening hypersensitivity reaction that can occur with certain medications, including carbamazepine and allopurinol. It is characterized by:
- Fever
- Rash
- Lymphadenopathy
- Facial swelling
- Involvement of other organ systems, such as:
- Hepatitis
- Nephritis
- Hematologic abnormalities
- Myocarditis
- Myositis
- Eosinophilia is often present DRESS can resemble an acute viral infection and may be fatal or life-threatening. If signs or symptoms of DRESS are present, the patient should be evaluated immediately and the offending medication should be discontinued if an alternative etiology cannot be established 2, 2, 3.
From the Research
Definition and Overview
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe, systemic, T cell mediated drug reaction with combinations of cutaneous, hematologic, and internal organ involvement 4.
- It is also known as drug-induced hypersensitivity syndrome (DiHS) and is a rare, drug-induced severe adverse reaction that usually occurs 3-6 weeks after initial exposure to certain drugs 5.
- DRESS is characterized by fever, facial oedema, generalized skin rash, lymphadenopathy, haematological abnormalities, and internal organ involvement 5.
Clinical Features
- The clinical features of DRESS are delayed, stepwise, and heterogenous, making this syndrome challenging to recognize and diagnose 4.
- Common clinical features include morbilliform cutaneous eruption, fever, lymphadenopathy, and liver enzyme elevation 6, 7.
- The severity of DRESS is related to the systemic involvement, which can result in multi-organ failure 7.
Diagnosis
- Two sets of validated diagnostic criteria exist that can be employed to diagnose DRESS/DiHS 4.
- In vitro and in vivo tests can be employed to confirm the diagnosis and help identify culprit drugs 4.
- The RegiSCAR criteria (≥6 points) can be used to diagnose DRESS 5.
Treatment
- The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described 6.
- Prompt withdrawal of the culprit drug, supportive treatment, and immunosuppression depending on the severity of disease are essential for managing DRESS 4.
- Novel treatment approaches with targeted therapy, cyclosporine, intravenous immunoglobulin, and plasmapheresis have been gaining interest as alternative mono- and adjuvant therapies 8.
Prognosis and Management
- DRESS is a serious condition with significant morbidity and mortality, which requires more research for a better understanding 5.
- Early diagnosis and cessation of the causative agent are universally accepted as the initial interventions for DRESS 8.
- A DRESS management tool with step-by-step guidance can be used to provide clinicians with a toolbelt of resources with which to approach diagnosis, treatment, and follow-up 8.