Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis

doi:10.1016/j.jaad.2023.02.072

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis

2024-05-01

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Benjamin H. Kaffenberger

Elizabeth J. Phillips

DOI：10.1016/j.jaad.2023.02.072

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Abstract

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Drug -induced hypersensitivity syndrome (DiHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a severe cutaneous adverse reaction (SCAR) characterized by an exanthem, fever, and hematologic and visceral organ involvement. Anticonvulsants, antibiotics, and allopurinol are the most common triggers. The pathogenesis involves a complex interplay between drugs, viruses, and the immune system primarily mediated by T -cells. DiHS/DRESS typically presents with a morbilliform eruption 2-6 weeks after drug exposure, and is associated with significant morbidity, mortality, and risk of relapse. Long-term sequelae primarily relate to organ dysfunction and autoimmune diseases. Part I of this continuing medical education activity on DiHS/DRESS provides an update on epidemiology, novel insights into pathogenesis, and a description of clinicopathological features and prognosis. ( J Am Acad Dermatol 2024;90:885-908.)

Keywords:

delayed hypersensitivity reaction

DHR

DiHS

DRESS

drug-induced hypersensitivity syndrome

drug rash

drug reaction

drug reaction with eosinophilia and systemic symptoms

eosinophilia

exanthem

exanthematous drug eruption

hypersensitivity

maculopapular eruption

morbilliform eruption

SCAR

severe cutaneous adverse drug reaction

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis

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