Abstract
BackgroundA drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe T cell mediated hypersensitivity reaction. Relapses of symptoms in the recovery phase are frequent and linked to the reduction of the corticosteroid treatment, to viral reactivations or to the exposure to new drugs. Here, we analyzed, how often the exposure to new drugs leads to new sensitization or drug-related relapses without detectable sensitization.Methods46 patients with DRESS treated in the allergy division of the Inselspital, Bern University Hospital, were retrospectively assessed. Drug-related relapses were analyzed in terms of frequency and whether a possible sensitization evaluated by skin tests and/or lymphocyte transformation tests (LTT) to the new drugs was detectable. Furthermore, drug tolerance was evaluated in a subset of patients.Results56 relapses were observed in 27 of 46 patients with DRESS (58.7%). 33 (58.9%) of these relapses were associated with the use of new drugs, 30 drug-related relapses were evaluated by patch test and/or lymphocyte transformation test. In 8/30 (26.7%) drug-related relapses, a sensitization to the new drug was demonstrated, suggesting the emergence of a multiple drug hypersensitivity syndrome (MDH). 14 patients experienced 22 drug-related relapses without any detectable sensitization and only 1/6 patients developed new symptoms upon reexposure.ConclusionPatients with DRESS frequently suffered from drug related relapses. Half of the patients with drug-related relapses developed a MDH with proven sensitizations not only to the DRESS inducing drugs, but also to newly applied drugs. When not sensitized, drugs involved in drug related relapses could be reintroduced, if needed. Here, we propose a procedure for drug testing and future management of drug-related relapses in DRESS.
Highlights
Drug reactions with eosinophilia and systemic symptoms (DRESS), called drug induced hypersensitivity syndrome (DiHS) are severe T cell mediated drug hypersensitivity reactions (DHRs), leading to exanthema, fever, Jörg et al Clin Transl Allergy (2020) 10:52 periods (< 14 days) have been observed [6]
The aim of this study was to assess the frequency of drug-related relapses and to evaluate whether skin tests and/or lymphocyte transformation tests are useful in drug-related relapses to identify patients with multiple drug hypersensitivity syndrome (MDH)
Study population All drug reaction with eosinophilia and systemic symptoms (DRESS) cases were evaluated based on the Regiscar scoring system [18], which classifies a DRESS as definitive case (≥ 6 points), probable case (4–5 points), possible case (2–3 points) or no case (< 2 points)
Summary
Drug reactions with eosinophilia and systemic symptoms (DRESS), called drug induced hypersensitivity syndrome (DiHS) are severe T cell mediated drug hypersensitivity reactions (DHRs), leading to exanthema, fever, Jörg et al Clin Transl Allergy (2020) 10:52 periods (< 14 days) have been observed [6]. Drug-related relapses, for which sensitization to the newly introduced drug has not been proven may be associated with an unknown mechanism such as stimulation of already activated T cells In these cases patients may tolerate the suspected drug after complete recovery from the relapse. Some patients showed a new T cell sensitization to the causing drug, leading to a multiple drug hypersensitivity syndrome (MDH) [14,15,16]. These patients are at risk of developing a drug hypersensitivity on re-exposure [17], they have to avoid multiple structurally different drugs. We analyzed, how often the exposure to new drugs leads to new sensitization or drug-related relapses without detectable sensitization
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