An investigation into the avoidability of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rising morbidity amongst hospitalized patients. Whilst clinical protocols for the management of individual DRESS cases have been well established, determination of potential prevention of these cases by utilizing novel “avoidability” tools has remained unexplored. This retrospective study reviewed records of patients who presented to the emergency department of Weill Cornell Medicine-affiliated Hamad General Hospital, Doha Qatar with suspected DRESS syndrome. These cases were independently adjudicated (utilizing the RegiSCAR, and JSCAR tools) as DRESS-drug pairs by a team of two clinical pharmacists and two General Physicians. They were then rated for potential avoidability with the Liverpool adverse drug reactions avoidability tool (LAAT) by the same team of raters. A total of 16 patients satisfied RegiSCAR criteria for DRESS syndrome. The mean age of the study population was 41.5 years (SD ± 13.3). The study population was predominantly male (n = 12; [75%]). The median latent period from drug ingestion to clinical presentation was 14 days (interquartile range [IQR] 6.5, 29). The median RegiSCAR and J-SCAR scores were 6 (IQR 5, 6.8), 5 (IQR 4, 5.8) respectively. Utilizing the LAAT, about 60% of the DRESS syndrome-drug pairs were rated as “avoidable” (“probable” or “definite”). The overall Krippendorf’s alpha with the LAAT was 0.81 (SE 0.10, CI 0.59–1.00); with an intraclass correlation coefficient (ICC) of 0.90 (CI 0.77, 0.96.). In a randomly selected cohort of DRESS syndrome-drug pairs, a significant proportion was potentially avoidable (“possibly” and “definitely”) utilizing the LAAT. This will need validation by larger sample-sized prospective studies utilizing the updated LAAT proposed by this study.

The determination of causality of drug induced liver injury in patients with COVID-19 clinical syndrome

“…Our results demonstrated a nonsignificant difference between the two rating specialties (general physicians and clinical pharmacists) in the proportion of EA and ED. Physicians and pharmacists have shown comparable results in utilizing other diagnostic and causality determination tools, including the updated RUCAM scale amongst others [ 10 , 22 , 23 ]. This suggests that these tools are inherently objective, and do not require extensive knowledge of clinical pharmacology for their clinical application.…”

Patch Testing as a Diagnostic Method for DRESS Syndrome That Brings Us Closer to a Certain Result: Letter to the Editor

“…The concept of avoidability is a fast-evolving topic in pharmacoepidemiology [2][3][4][5]. We were the first to explore the potential utility of the well-validated Liverpool adverse reaction avoidability tool (LAAT) in patients with DRESS syndrome [6]. In our published report exploring the clinical utility of the LAAT in patients with DRESS syndrome (N = 16) and median (IQR) RegiSCAR and J-SCAR scores of 6 (5-6.8) and 5 (4-5.8), respectively, we found that about 60% of the DRESS syndrome drug pairs were rated as "avoidable" ("probable" or "definite").…”