The following is a summary of “Drug Reaction With Eosinophilia and Systemic Symptoms: A Systematic Review,” published in the June 2023 issue of Allergy and Clinical Immunology by Awad et al.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially fatal drug reaction; recognizing the diversity of its clinical manifestations, implicated drugs, and management strategies can aid in diagnosis and reduce morbidity and mortality. The goal is to examine the clinical characteristics, drug causes, and treatments utilized in DRESS. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to examine DRESS-related publications published between 1979 and 2021. Only publications with a RegiSCAR score of 4 or higher (indicating “probable” or “definite” DRESS) were considered. 

For data extraction, the PRISMA guidelines and the Newcastle-Ottawa scale were used (Pierson DJ. Respir Care 2009;54:1372-8). For each publication in the analysis, the primary outcomes included implicated medications, patient demographics, clinical manifestations, treatment, and sequelae. About 1,124 publications were examined, and 131 met the inclusion criteria, totaling 151 instances of DRESS. Antibiotics, anticonvulsants, and anti-inflammatory pharmaceuticals were the most implicated drug classes, although up to 55 were involved. In 99% of cases, cutaneous manifestations were evident, with a median onset of 24 days and maculopapular rash being the most general morphology. Frequent systemic manifestations included fever, eosinophilia, lymphadenopathy, and liver involvement. In 67 cases (44%), facial edema was observed. 

Systemic corticosteroids were the cornerstone of treatment for DRESS. 13 cases (or 9%) resulted in fatalities. DRESS should be considered in the presence of a cutaneous eruption, fever, eosinophilia, liver involvement, and lymphadenopathy. Allopurinol was associated with 23% of cases that resulted in mortality (3 points), suggesting that the drug class may influence the outcome. Given the potential complications and mortality associated with DRESS, DRESS must be recognized early so that any suspect medications can be discontinued promptly.

Source: sciencedirect.com/science/article/abs/pii/S2213219823002404