Drug reaction with eosinophilia and systemic symptoms: An update and review of recent literature

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, is also known as drug induced hypersensitivity syndrome and by various other names. It is now recognised as one of the severe cutaneous adverse reaction (SCAR) and can be potentially life-threatening. Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome. However, it was later found to be caused by various other medications. Anticonvulsants and sulfonamides are the most common offender. Characteristically DRESS has a latent period of 2 to 6 weeks. The pathophysiology remains incompletely understood but involves reactivation of viruses and activation of lymphocyte. It is manifested most commonly with a morbilliform cutaneous eruption with fever and lymphadenopathy. The severity of this syndrome is related to the systemic involvement, which can result in multi-organ failure. Most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug. Patients of DRESS syndrome should be managed in an intensive care set up for appropriate supportive care and infection control. Topical corticosteroids can give symptomatic relief, but systemic therapy with steroid and other immunosuppressant is usually required.

Phenobarbital-induced anticonvulsant hypersensitivity syndrome in a cat

“…Anticonvulsant hypersensitivity syndrome (AHS) is a delayed adverse drug reaction associated with the use of aromatic anticonvulsant drugs [4,5,7]. It is mainly caused by drugs such as phenytoin, phenobarbital, and carbamazepine.…”

Carbamazepine Induced Dress Syndrome : A Case Report

“…It consists of 8 parameters that include acute rash, fever above 38 0 C, 962 lymphadenopathy at two sites, involvement of at least one internal organ, abnormalities in lymphocytes & eosinophilis count, resolution ≥ 15 days and negative results in atleast 3 serological tests. 1,12 To meet the definition of DRESS syndrome, the patient must have any 5 of the above 8 parameters. In this case, the patient was observed to meet the definition of RegiSCAR with the precipitating symptoms like erythematous rash, fever, facial edema, swelling of ear lobe, eyelid & fingers.…”

“…The mortality rate is approximately 10% and the rate of incidence of dress syndrome ranges from 1 in 1,000 to 1 in 10,000 drug exposures. [1][2][3][4] Adults are more prone to dress syndrome when compared to children. There are around 50 culprit drugs which can induce dress syndrome.…”

HLA‐associated antiepileptic drug‐induced cutaneous adverse reactions

“…For HLA‐A*31:01 risk association a similar trend was observed, with only a minority of HLA‐A*31:01 positive individuals (PPV range: 0.59%‐12.7%; sensitivity range: 50%‐70%) developing AED‐induced cADRs (Table ). The low PPVs are not unexpected since the prevalence of DRESS and SJS/TEN occur in low frequencies (from 0.001% to 0.025%) in at risk populations. Consequently, these data suggest that there may be other unaccounted gene variants, epigenetic or environmental contributing factors influencing risk.…”

“…8 Carbamazepine is also widely used to treat neuropathic pain, and both carbamazepine and lamotrigine are used in the management of bipolar affective disorder. Unfortunately, up to 1 in 10 new patients prescribed these medications will go on to develop MPE, 9 whilst the incidences of both DRESS and SJS/TEN have been estimated at 1 in 1000 to 1 in 10 000, 10,11 with an alarming incidence of 1 in 400 for SJS/TEN in at risk populations (ie, Han Chinese descent). 12 There have been many investigations of genomic contributions that modulate risk for development of these hypersensitivity reactions.…”