DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS: A COMPREHENSIVE REVIEW OF THE LITERATURE

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) or drug-induced hypersensitivity syndrome is a serious form of cutaneous drug reactions resulting from a cell-mediated immune process with characteristic delay in onset, fever, edematous morbilliform rash, lymphadenopathy, eosinophilia or atypical lymphocytes, and typical involvement of internal organs. The diagnostic criteria consist of a structured assessment according to the RegiSCAR score or Japanese consensus criteria with differential exclusion of look-alikes followed by identification of the drug trigger. It is attributed to the presentation of antigens from the offending drug to specific HLA molecules with predominance of cytotoxic and type 2 lymphocyte responses. High-risk drugs include aromatic anti-epileptics, allopurinol, sulfonamide antibiotics and dapsone, tetracyclines and vancomycin, anti-tubercular drugs, and selected anti-retroviral drugs. Withdrawing the offending drug immediately and hospital care is primary. Cyclosporin is sometimes considered as second-line treatment for corticosteroid-refractoriness or corticosteroid-contraindications. In turn IVIG and targeted therapy against IL-5 or IL-5 receptors could have role in carefully chosen patients. Primary causes of cases leading to death include acute hepatopathy, myocarditis resultant to respiratory insufficiency or sepsis. Others include type-1 diabetes mellitus or autoimmunity to thyroid or chronic renal diseases. A very large proportion of cases could be certainly prevented with pharmacogenetics screening methods such as analysis for allopurinol and/or HLA-B*58:01 or screening for Abacavir with HLA-B*57:01 before their administration.