A Shorter Time to Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Redefining Beta-Lactam-Associated DRESS.

Abstract

To the editor—Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction (SCAR) that can occur with medication exposure, including antibiotics [1]. DRESS is characterized by diffuse rash, eosinophilia, and organ dysfunction. However, clinical presentation can be heterogenous [2], making standardized diagnostic criteria proposed by the RegiSCAR group critical to identification of DRESS [3]. Presentation is typically delayed with traditional teaching, suggesting symptom onset occurs 2–6 weeks following medication exposure [4]. Recent studies suggest a potentially shorter drug latency with antibiotic-associated DRESS [5]. However, the latency of confirmed beta-lactam DRESS in direct comparison with other antibiotic groups remains unknown. Using 2 previously published prospective multicenter cohorts of antibiotic hypersensitivity–tested patients from Melbourne, Australia, we identified patients with antibiotic-associated DRESS between April 2015 and June 2022 and compared patients with beta-lactam DRESS and vancomycin DRESS [6–8]. Adult (aged ≥18 years) patients who reported beta-lactam or vancomycin-associated DRESS, had a RegiSCAR score [3] of >2 (possible, probable, or definite DRESS), and had positive testing to the implicated antibiotic via a previously published ex vivo T-cell assay (enzyme-linked immunosorbent spot) or skin testing (ST; intradermal or patch test using previously deployed nonirritant concentrations of antibiotic) [7] were included. Patients with vancomycin DRESS also underwent human leukocyte antigen (HLA) typing for HLA-A*32:01, a known pharmacogenomic association [9]. DRESS patients positive to both vancomycin and a beta-lactam on any testing were excluded. Drug latency was defined as time from drug commencement until onset of DRESS. One sample Wilcoxon signed rank test was used to compare latency of beta-lactam DRESS with reported latency of 14 days, while linear regression was used for comparison with vancomycin latency.