Clinical course of drug‐induced hypersensitivity syndrome treated without systemic corticosteroids

Uhara, Hisashi; Saiki, Megumi; Kawachi, Shigeo; Ashida, Atsuko; Oguchi, Shinji; Okuyama, Ryuhei

doi:10.1111/j.1468-3083.2012.04547.x

Cited by 40 publications

(34 citation statements)

References 15 publications

(47 reference statements)

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“…It might be speculated that the delay in these cases is related to reactivation of HHV6. It is also interesting to note that the median number of days between the first day of drug administration and the first day of onset of symptoms of fever or rash in this series ( n = 28) is 9 (IQR 4·5–14·5), which is similar to the median number of days in the study of Uhara et al . of 10·5 (IQR 4–16).…”

Section: Discussionsupporting

confidence: 82%

“…Among those negative for HHV6, 20 patients were treated with systemic corticosteroids (median total dose 5 mg kg À1 , range 1-16) and five patients were managed with supportive therapy alone. All four patients positive for HHV6 were treated with systemic corticosteroids (median total dose 6Á5 mg kg À1 , range [2][3][4][5][6][7][8][9][10][11][12][13][14]. Systemic corticosteroids were administered either intravenously or orally.…”

Section: Resultsmentioning

confidence: 99%

“…5,6,9 Although systemic corticosteroids have been the mainstay of treatment, their efficacy remains controversial. 3,5,[10][11][12][13][14] This study evaluated paediatric patients with DHS who had concomitant expression of HHV6 on the basis of increased viral copy number on PCR studies, to determine whether they present with a different disease course from those with DHS who do not have evidence of HHV6 infection or reactivation. Secondarily, this study also evaluated the responses to systemic corticosteroid therapy in these subpopulations.…”

Section: What Does This Study Add?mentioning

confidence: 99%

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Human herpesvirus 6 involvement in paediatric drug hypersensitivity syndrome

et al. 2015

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Background HHV6-positivity in context of drug hypersensitivity syndrome (DHS) may influence disease severity. Systemic corticosteroid treatment of those with DHS, testing positive for HHV6, has been speculated to prolong the duration of disease. Objectives This study's objectives are to: (1) Evaluate whether DHS patients with HHV6-positivity develop a more severe illness compared to DHS patients without presumed reactivation in the pediatric population, and (2) Evaluate the response to systemic corticosteroid treatment. Methods Retrospective case series of 29 pediatric inpatients treated for DHS and tested for HHV6. HHV6-positive and -negative patients were identified and stratified to groups treated with and without systemic corticosteroids to examine their disease severity on the basis of hospital length-of-stay (LOS), total number of febrile days (Tfeb), and days until cessation of progression (CTP). Results HHV6-positive patients had similar demographic characteristics as HHV6-negative patients, but had significantly longer hospital LOS (11.5 days v 5 days, p=0.0386), Tfeb (12.5 days v 3 days, p=0.0325), and CTP (4 days v 2 days, p=0.0141). All HHV6-positive patients and most (80%) of the HHV6-negative patients received systemic corticosteroids. Among the HHV6-negative patients, those who received corticosteroids showed significantly shorter CTP than those who did not receive corticosteroids (3 days v 2 days, p=0.043). Additionally, there was a trend towards shorter hospital LOS and Tfeb among HHV6-negative patients who received corticosteroids when compared with those who did not, though these differences were not statistically significant. The most common inciting drugs included trimethoprim-sulfamethoxazole (33%), phenytoin (10%), and amoxicillin (10%). Conclusions HHV6-positivity with DHS is associated with a more severe disease course. Treatment with systemic corticosteroids was associated with a non-statistical trend toward reduced hospital LOS and febrile days, and a statistically reduced number of days until cessation of progression.

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Section: Discussionsupporting

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: What Does This Study Add?mentioning

confidence: 99%

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Human herpesvirus 6 involvement in paediatric drug hypersensitivity syndrome

et al. 2015

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“…Several authors have reported autoimmune disease occurrence and/or autoantibody production during a period of several months to years after the resolution of DRESS/DIHS, including diabetes mellitus type 1, lupus erythematosus, Hashimoto thyroiditis, enteropathy, sclerodermiform lesion‐type graft‐versus‐host disease and bullous pemphigoid . In the present study, none of the definite cases of DRESS/DIHS had any autoimmune disease detected before 2012.…”

Section: Discussioncontrasting

confidence: 42%

Drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome: clinical features of 27 patients

et al. 2015

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“…Uhara et al reported on 12 patients with DiHS who received hydration with or without topical steroids [120]. All of these 12 patients recovered well, without complications of infections, within 7 to 37 days after the withdrawal of the inciting drugs.…”

Section: Treatmentsmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

Cho

Yang

Chu

2017

IJMS

205

276

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan hypersensitivity reaction mostly caused by a limited number of eliciting drugs in patients with a genetic predisposition. Patients with DRESS syndrome present with characteristic but variable clinical and pathological features. Reactivation of human herpesviruses (HHV), especially HHV-6, is the hallmark of the disease. Anti-viral immune responses intertwined with drug hypersensitivity make the disease more complicated and protracted. In recent years, emerging studies have outlined the disease more clearly, though several important questions remain unresolved. In this review, we provide an overview of DRESS syndrome, including clinical presentations, histopathological features, pathomechanisms, and treatments.

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Clinical course of drug‐induced hypersensitivity syndrome treated without systemic corticosteroids

Abstract: It might be unnecessary to give systemic corticosteroids immediately to all patients suspected of having DIHS.

Cited by 40 publications

References 15 publications

Human herpesvirus 6 involvement in paediatric drug hypersensitivity syndrome

Human herpesvirus 6 involvement in paediatric drug hypersensitivity syndrome

Drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome: clinical features of 27 patients

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

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