Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Identified in the Electronic Health Record Allergy Module

Wolfson, Anna R.; Zhou, Li; Liu, Yu; Phadke, Neelam A.; Chow, Ohn A.; Blumenthal, Kimberly G.

doi:10.1016/j.jaip.2018.08.013

Cited by 105 publications

(75 citation statements)

References 33 publications

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“…We found that cutaneous reactions comprised a majority (56.1%) of all HSRs. Prior studies have similarly found that cutaneous reactions are common; dermatologic ADRs were identified to be the most common type of ADRs that was treated in the emergency department (26.3%) [20]. Except for rash, delayed HSR phenotypes were uncommon, as expected.…”

Section: Discussionsupporting

confidence: 51%

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Drug Hypersensitivity Reactions Documented in Electronic Health Records within a Large Health System

Wong

Seger

Lai

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

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Background: Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety. Objective: To examine HSR epidemiology using longitudinal EHR data from a large United States healthcare system. Methods: Patient demographic information and drug allergy data were obtained from the Partners Enterprise-wide Allergy Repository (PEAR) for two large tertiary care hospitals from 2000 to 2013. Drug-induced HSRs were categorized into immediate and delayed HSRs based on typical phenotypes. Causative drugs and drug groups were assessed. The prevalence of HSRs were determined, and sex and racial differences were analyzed.

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Section: Discussionsupporting

confidence: 51%

“…However, our SCAR cases have not been validated to date. Prior SCAR validation using an extensive keyword search on EHR allergy list [20] and diagnostic codes [38] has demonstrated low (13-14%) validation.…”

Section: Discussionmentioning

confidence: 99%

Drug Hypersensitivity Reactions Documented in Electronic Health Records within a Large Health System

Wong

Seger

Lai

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

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“…In line with our results, Kim et al [48] showed that although the incidence of hospitalization due to the occurrence of SCARs is < 1/1000 person-year, the in-hospital mortality is around 27%. Further studies confirmed that SCARs frequently led to patients' hospitalization and unfavorable outcomes [49][50][51][52] and that these ADRs were often acute emergencies [53]. However, a reporting bias cannot be ruled out.…”

Section: Overall Resultsmentioning

confidence: 99%

Severe Cutaneous Adverse Drug Reactions Associated with Allopurinol: An Analysis of Spontaneous Reporting System in Southern Italy

Scavone

Mauro

Ruggiero

et al. 2019

Drugs - Real World Outcomes

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Background Allopurinol can induce severe cutaneous adverse reactions (SCARs), including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Aims and Methods We analyzed the Individual Case Safety Reports (ICSRs) sent from January 2001 until April 2019 to the Campania regional Center of Pharmacovigilance (Southern Italy) that reported allopurinol as suspected, with a focus on those reporting at least one serious cutaneous adverse drug reaction (ADR). This study was aimed to describe the main characteristics of all ADRs associated with allopurinol, analyze the proportion of serious cutaneous ADRs of total ICSRs related to allopurinol and to compare the main features (age, sex, seriousness and outcome) of ICSRs that reported serious cutaneous ADRs with those that did not. Results The Campania regional Center of Pharmacovigilance received 108 ICSRs that reported allopurinol as suspected. ADRs occurred more frequently in the elderly (median age: 71 years) and female patients (53.7%). Fifty-seven percent of all ADRs were classified as serious and 58% had a favorable outcome. Fifty-six ICSRs reported at least one serious cutaneous ADR; among these ICSRs, 37 cases of SCARs were found [DRESS syndrome (n = 3; 5.4%), SJS (n = 8; 14.3%) and TEN (n = 26; 46.4%)]. Serious cutaneous ADRs commonly occurred in the elderly (median age: 73 years) and female patients (62.5%). They frequently required hospitalization (75%) and had an unfavorable outcome (46%). No statistically significant differences were found between ICSRs that reported serious cutaneous ADRs and ICSRs that did not report serious cutaneous ADRs except for the seriousness degree "Hospitalization or its prolongation" and the outcome degrees "Unfavorable" and "Favorable". Conclusion This study found that 52% (56/108) of all ICSRs having allopurinol as a suspected drug were serious cutaneous ADRs. Serious cutaneous ADRs associated with allopurinol frequently required hospitalization or prolonged hospitalization, and almost half had an unfavorable outcome.

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“…A recently published case series proposed that 15–37% of DRESS syndrome may be caused by antibiotics [ 16 ]. In an electronic health record review in the USA, from 1980 to 2016, antibiotics were attributed to DRESS syndrome in 74% of cases (vancomycin [39%], β-lactams [23%], fluoroquinolones [4%], tetracyclines [4%], and sulfonamides [3%]) [ 20 ]. Overall, the severity of the antibiotic-induced DRESS in comparison with other culprits is controversial.…”

Section: Introductionmentioning

confidence: 99%

Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review

Sharifzadeh

Mohammadpour

Tavanaee

et al. 2020

Eur J Clin Pharmacol

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Background Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is a delayed infrequent potentially lifethreatening idiosyncratic drug reaction. Aromatic anticonvulsants and allopurinol are the most frequent causative agents. However, various reports of antibiotic-induced DRESS are available. In this review, we try to summarize reports of antibacterial antibiotic-induced DRESS focusing on characteristics of DRESS induced by each antibiotic group. Methods The data were collected by searching PubMed/MEDLINE and ScienceDirect. The keywords used as search terms were "DRESS syndrome," "drug-induced hypersensitivity syndrome (DIHS)," "antibiotics," "antimicrobial," and names of various antimicrobial groups. Finally, 254 relevant cases with a definite or probable diagnosis of DRESS based on RegiSCAR criteria were found until 30 May 2020 and reviewed. Results and conclusion Totally, 254 cases of antibacterial antibiotic-induced DRESS are reported. Most of them are related to antituberculosis drugs, vancomycin, and sulfonamides, respectively. Rash and fever were most frequent clinical findings. Eosinophilia and liver injury were the most reported hematologic and visceral organ involvement, respectively. Most of the patients are managed with systemic corticosteroids. The death occurred in 16 patients which most of them experienced liver or lung involvement. The reactivation of various viruses especially HHV-6 is reported in 33 cases. The mean latency period was 29 days. It is necessary to perform thorough epidemiological, genetic, and immunological studies, also systematic case review and causality assessment, as well as well-designed clinical trials for better management of antibiotic-induced DRESS.

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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Identified in the Electronic Health Record Allergy Module

Abstract: Using free-text search of the EHR allergy module identified a large US DRESS syndrome cohort. DRESS prevalence was 2.18 per 100,000 patients. Both liver and kidney injury were frequent, and vancomycin was the most common drug culprit. DRESS cases were morbid and resource-intensive.

Cited by 105 publications

References 33 publications

Drug Hypersensitivity Reactions Documented in Electronic Health Records within a Large Health System

Drug Hypersensitivity Reactions Documented in Electronic Health Records within a Large Health System

Severe Cutaneous Adverse Drug Reactions Associated with Allopurinol: An Analysis of Spontaneous Reporting System in Southern Italy

Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review

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