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Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come?

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Abstract

Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants characterized by fever, liver enzyme elevation, and skin changes, our continuously growing understanding of this entity has allowed us to describe its physiopathology and clinical features even further. The relationship of genetic factors, viral activation, and specific drug exposure is now known to play a role in this disease. There is still not a widely accepted marker for DReSS/DiHS, but the spectrum of clinical and laboratory features has now been better outlined. The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described. We present a comprehensive review of the literature on DReSS/DiHS, focusing on its history, etiopathogenesis, diagnosis, therapeutic approach, and outcome.

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Notes

  1. We use the acronym DReSS, with a lower-case ‘e’ representing eosinophilia. The lower case helps enforce the need to look for hematologic changes such as eosinophilia as well as atypical lymphocytosis, and to make it clear that eosinophilia is not necessary to diagnose DReSS as a syndrome.

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Author notes

  1. Fabian Rodríguez-Bolaños and Sylvia Martínez-Cabriales contributed equally in the preparation of this manuscript.

Authors and Affiliations

  1. Department of Dermatology, University of Toronto, Toronto, Canada

    Sylvia Aide Martínez-Cabriales, Fabian Rodríguez-Bolaños & Neil H. Shear

  2. Department of Dermatology, Autonomous University of Nuevo Leon, Monterrey, Mexico

    Sylvia Aide Martínez-Cabriales

  3. Dermatology Division, Sunnybrook Health Sciences Centre, Toronto, Canada

    Sylvia Aide Martínez-Cabriales, Fabian Rodríguez-Bolaños & Neil H. Shear

Authors
  1. Sylvia Aide Martínez-Cabriales
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  2. Fabian Rodríguez-Bolaños
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  3. Neil H. Shear
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Corresponding author

Correspondence to Neil H. Shear.

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No funding was received for the preparation of this review.

Conflict of interest

S.A. Martinez-Cabriales, F. Rodriguez-Bolaños, and N.F. Shear declare that they have no conflicts of interest.

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Martínez-Cabriales, S.A., Rodríguez-Bolaños, F. & Shear, N.H. Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come?. Am J Clin Dermatol 20, 217–236 (2019). https://doi.org/10.1007/s40257-018-00416-4

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