Can we allow a further intake of drugs poorly suspected as responsible in drug reaction with eosinophilia and systemic symptoms (<scp>DRESS</scp>)? A study of practice

Desroche, Tannvir; Poreaux, C.; Waton, J.; Schmutz, J.‐L.; Ménétré, Sarah; Barbaud, A.

doi:10.1111/cea.13380

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…6,7 A similar approach to that described above has been proposed and carried out in patients with DRESS syndrome. 8 There are few reported cases of intentional or unintentional reexposure to the drug involved in SCAR, 7,[9][10][11] and even fewer cases in pediatric patients, [12][13][14] mostly with satisfactory results. A recent study has shown the ability of high-dose intravenous corticosteroids to reverse the recurrence of symptoms during DPT in patients with SJS and DRESS syndrome, potentially improving the safety of drug rechallenge protocols in these patients.…”

Section: Discussionmentioning

confidence: 99%

Drug reexposure in children with severe mucocutaneous reactions

Moral

Toral

Gilabert

et al. 2022

aei

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In pediatric patients, severe cutaneous adverse reactions (SCARs) frequently occur in the course of acute illnesses, mostly infections, which are usually treated with antibiotics or analgesics. The drug provocation test (DPT) is contraindicated in such situations, due to the risk of triggering a new severe reaction. As a consequence, lifelong avoidance is recommended. However, causation is uncertain in most cases. The dilemma arises when avoiding the drug is not harmless for the patient. We have attended three patients who were referred to our pediatric allergy unit with a history of SCAR related in time to simultaneous use of paracetamol and ibuprofen. Medical records and images of the patients were reviewed with the assistance of a dermatologist, and alternative diagnoses were considered in both cases. The ALDEN score for implicated drugs was calculated. After considering a high probability of ibuprofen tolerance and obtaining informed consent from the patients, we performed a sequential allergy workup including in vitro tests, skin tests, and finally DPT in two of the patients, confirming ibuprofen tolerance. In conclusion, although generally contraindicated, DPT may be considered for some useful drugs after careful evaluation of the risk–benefit balance, preceded by a sequential study including in vitro and skin tests.

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Section: Discussionmentioning

confidence: 99%

Drug reexposure in children with severe mucocutaneous reactions

Moral

Toral

Gilabert

et al. 2022

aei

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“…Importantly, in DRESS, an allergy work‐up should be done >6 months following the disappearance of CADR 4 . The use of IDTs in the investigation of severe cutaneous adverse reactions (SCARs) remains controversial, although a recent study in a large population confirmed the good tolerance of IDTs in the work‐up of DRESS 17 if they are performed to study the absence of drug cross‐reactivity, and/or to eliminate multiple hypersensitivity to different drug classes 18 …”

Section: Which Tests Are Useful For Which Patients?mentioning

confidence: 99%

Skin tests in the work‐up of cutaneous adverse drug reactions: A review and update

2022

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Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE), as well as severe CADR, including toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and in particular, acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). To ensure their specificity, at least 10 control tests should be performed. Prick tests are mainly used in the evaluation of immediate-type hypersensitivity and can be performed with all drugs, except opiates. IDTs can be used to explore immediate and delayed-type hypersensitivity, if an injectable form of the drug exists. Except for SJS/TEN, IDTs should be performed by injecting 0.02 mL of the drug. We here provide a practical, up-to-date review on the use of these skin tests in the work-up of CADRs. Numerous negative controls for drug PTs, as well as criteria for the immediate and delayed positivity of prick tests and IDT, are included. It should be emphasized that a negative result never excludes the potential responsibility of a drug in a CADR.

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“…Desroche and colleagues looked at one example of this, drug reaction with eosinophilia and systemic symptoms (DRESS). 25 Here, it may not be possible to identify the exact trigger meaning patients may have to avoid many potentially helpful medications. Desroche and colleagues used a caution provocation approach to test 91 drugs in 33 patients-79 were tolerated with 9 patients having further DRESS or probable DRESS reactions, none serious.…”

Section: Drug Allergymentioning

confidence: 99%

“…There are some circumstances where allergist does not consider it prudent to test. Desroche and colleagues looked at one example of this, drug reaction with eosinophilia and systemic symptoms (DRESS) 25 . Here, it may not be possible to identify the exact trigger meaning patients may have to avoid many potentially helpful medications.…”

Section: Clinical Allergymentioning

confidence: 99%

Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy

Roberts

Almqvist

Boyle

et al. 2020

Clin Experimental Allergy

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In the second of two linked articles, we describe the development in clinical as described by Clinical & Experimental Allergy and other journals in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered.

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Can we allow a further intake of drugs poorly suspected as responsible in drug reaction with eosinophilia and systemic symptoms (DRESS)? A study of practice

Cited by 14 publications

References 8 publications

Drug reexposure in children with severe mucocutaneous reactions

Drug reexposure in children with severe mucocutaneous reactions

Skin tests in the work‐up of cutaneous adverse drug reactions: A review and update

Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy

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