Table of contents:

Clinical manifestations and incidence
Clinical picture of DRESS syndrome
Treatment

DRESS (Drug Rash with Eosinophilia and Systemie Syndrome) is the name for a syndrome characterised by a so-called drug rash accompanied by eosinophilia. DRESS syndrome is classified as a so-called severe hypersensitivity reaction to drugs. It occurs relatively rarely and is characterised by specific symptoms. Drug reactions, which manifest as severe hypersensitivity, may result from the mode of release of the active substance in the medication or from allergy to any of the product components (e.g. additives, preservatives).

Hypersensitivity can affect any organ, but in most cases symptoms appear on the skin. DRESS syndrome occurs after administration of anticonvulsants. The first mention of the possible induction of side effects by phenytoin and other anticonvulsants was described by Saltzstein and Ackerman. Symptoms, similar to those described by Saltzstein and Ackerman, have also begun to be observed following the administration of products such as allopurinol, cephalosporins, anti-inflammatory drugs and sulphonamide derivatives. Hence, additional extensions of the name DRESS-DIHS (Drug Induced Hypersensitivity Syndrome), DRESS/DIHS, HSS (Hypersensitivity Syndrome), HSS/DRESS can be found in the literature. The term DRESS was first proposed by dermatologist Bocquet in 1996.

Clinical manifestations and incidence

Hypersensitivity to drugs manifesting as DRESS syndrome ranges from 1/1000 to 1/10000 people who have taken drugs. The mortality rate of DRESS syndrome can be as high as 10%. The high mortality rate is mainly due to the fact that DRESS syndrome appears not only on the skin, but also affects internal organs. Importantly, the symptoms of DR ESS syndrome do not occur immediately after ingestion of a particular medicinal product - according to clinical data, they can appear up to 8 weeks after ingestion of the medicinal product.

DRESS syndrome, photo: panthermedia

Clinical picture of DRESS syndrome

Theclinical picture of the disease is variable, resulting in problems in making a definite diagnosis. A characteristic feature of DRESS syndrome is the appearance of skin lesions - skin eruptions that take the form of an acute or erythematous rash with a strong tendency to cluster. These types of lesions, when they merge, can lead to swelling. Another characteristic symptom of DRESS synd rome is exfoliation of the epidermis with associated symptoms such as blisters, erythema multiforme-type lesions, papules, pustules and even lichen-like lesions. Interestingly, there are described cases of DRESS syndrome in which no skin symptoms have been reported. Further symptoms that can be observed in patients are changes in the blood picture, which may be accompanied by cytosis, monocytosis or neutrophilia. DRESS syndrome can also involve internal organs - liver, kidneys, lungs, pancreas, gastrointestinal tract, spleen. Unfortunately, due to the extent of the symptoms, an unequivocal diagnosis is difficult to make, hence, according to the literature, it is worth relying on the Bocquet criteria, which allow the disease to be diagnosed more easily. However, the pathogenesis of the disease is not fully understood. In addition to drugs such as carbamazepine, phenytoin, phenobarbital, allopurinol or antibiotics (e.g. sulphonamides), DRESS syndrome may also be caused by Epstein-Barr virus, cytomegalovirus, hepatitis A, B and C virus, tuberculosis, toxoplasmosis, Lyme disease, parvovirus B19 or Still's disease. The course of the hypersensitivity reaction and its severity depends on the individual predisposition of the patient, although, according to many scientists, a major role is played by the correct functioning of the antigens of the tissue compatibility system - HLA. In the case of HLA malfunction, there is a risk of immune system dysfunction, which may be associated with an increased likelihood of adverse reactions following the administration of a medicinal product. Research indicates that patients who have the HLA-A11 antigen are at greater risk of developing hepatic lesions following antidepressant ingestion.

Treatment

As the main cause of DRESS syndrome is drug hypersensitivity, a comprehensive medical history plays a key role. Rapid identification of the cause allows elimination of the drug that caused the hypersensitivity reaction. Medical consultation is essential in the treatment of DR ESS syndrome - as it enables the elimination of other causes that may have led to symptoms suggestive of DRESS syndrome. Treatment is selected individually depending on the severity of the patient's symptoms and condition. It should be remembered that the mortality rate among patients suffering from DRESS syndrome is more than 10%, therefore any symptoms suggestive of hypersensitivity to medicinal products should not be underestimated.

The use of any medicinal product is always associated with the possibility of side effects, including DRESS syndrome. The appearance of any worrying symptoms after taking a medicinal product should motivate us to see a doctor as soon as possible. We should remember that medicinal products that have been injected into the body and have triggered a negative response from the immune system must be counteracted with effective therapy that is only available with a doctor's prescription. Prompt consultation of a doctor offers a great chance of a rapid recovery.

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