Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms

Abstract

ImportanceDrug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment.ObjectiveTo reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS.Design, Setting, and ParticipantsThe Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022.Main Outcomes/MeasuresThe degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1.ResultsIn the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup.Conclusions and RelevanceThis Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

Relevance of Human Herpesvirus 6 Reactivation in Drug Rash With Eosinophilia and Systemic Symptoms—Reply

“…In Reply We appreciate the interest in and valuable thoughts of Zhu et al on our international Delphi consensus on the treatment of adult patients with drug reaction with eosinophilia and systemic symptoms (DRESS) . We thank them for their reflections on the role of human herpesvirus 6 (HHV-6) reactivation in DRESS.…”

Relevance of Human Herpesvirus 6 Reactivation in Drug Rash With Eosinophilia and Systemic Symptoms

“…To the Editor We read the article by Brüggen et al that outlined international consensus guidelines for the management of drug rash with eosinophilia and systemic symptoms (DRESS) with great interest . These were the first guidelines published that formally recommended routine screening for human herpesviruses: cytomegalovirus (CMV), Epstein-Barr virus, and human herpesvirus 6A (HHV-6A) and 6B (HHV-6B).…”