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Review
. 2020;30(4):229-253.
doi: 10.18176/jiaci.0480. Epub 2020 Jan 14.

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome

R Cabañas  1   2   3   4 , E Ramírez  2   3   5 , E Sendagorta  3   6 , R Alamar  7 , R Barranco  3   8   9 , N Blanca-López  10 , I Doña  11   12 , J Fernández  13 , I Garcia-Nunez  14 , J García-Samaniego  15 , R Lopez-Rico  16 , E Marín-Serrano  17 , C Mérida  18 , M Moya  19 , N R Ortega-Rodríguez  20 , B Rivas Becerra  2   21 , P Rojas-Perez-Ezquerra  3   22 , M J Sánchez-González  3   23 , C Vega-Cabrera  2   21 , C Vila-Albelda  24 , T Bellón  2   3   25
Affiliations
Free article
Review

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome

R Cabañas et al. J Investig Allergol Clin Immunol. 2020.
Free article

Abstract

Background and objective: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines.

Methods: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts.

Results: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Keywords: Corticosteroids; DRESS syndrome; Drug reaction with eosinophilia and systemic symptoms; Drug-induced hypersensitivity syndrome; Lymphocyte transformation test; Patch tests; SCAR; Skin tests.

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