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Review
. 2022 Apr 26;10(5):999.
doi: 10.3390/biomedicines10050999.

Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS)/Drug-Induced Hypersensitivity Syndrome (DiHS)-Readdressing the DReSS

Hannah Stirton  1   2 , Neil H Shear  3 , Roni P Dodiuk-Gad  3   4   5
Affiliations
Review

Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS)/Drug-Induced Hypersensitivity Syndrome (DiHS)-Readdressing the DReSS

Hannah Stirton et al. Biomedicines. .

Abstract

Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is a severe, systemic, T cell mediated drug reaction with combinations of cutaneous, hematologic, and internal organ involvement. Pathogenesis of DReSS is multi-factorial, involving drug-exposure, genetic predisposition through specific human leukocyte antigen (HLA) alleles and metabolism defects, viral reactivation, and immune dysregulation. Clinical features of this condition are delayed, stepwise, and heterogenous, making this syndrome challenging to recognize and diagnose. Two sets of validated diagnostic criteria exist that can be employed to diagnose DReSS/DiHS. Methods to improve early recognition of DReSS and predict disease severity has been a recent area of research focus. In vitro and in vivo tests can be employed to confirm the diagnosis and help identify culprit drugs. The mainstay treatment of DReSS is prompt withdrawal of the culprit drug, supportive treatment, and immunosuppression depending on the severity of disease. We present a comprehensive review on the most recent research and literature on DReSS, with emphasis on pathogenesis, clinical features, diagnosis, confirmatory testing modalities, and treatment. Additionally, this summary aims to highlight the differing viewpoints on this severe disease and broaden our perspective on the condition known as DReSS.

Keywords: delayed hypersensitivity; drug reaction; drug reaction with eosinophilia and systemic symptoms; drug-induced hypersensitivity syndrome; human leukocyte antigen (HLA); regulatory T cells; viral reactivation.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
“Swiss cheese” risk model of DReSS/DiHS. CYP cytochrome P450, HLA human leukocyte antigen, DReSS drug reaction with eosinophilia and systemic symptoms, DiHS drug induced hypersensitivity syndrome.
See this image and copyright information in PMC

References

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