Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis - 11/04/24

Doi : 10.1016/j.jaad.2023.02.072

Brian M. Wei, BS ^a, Lindy P. Fox, MD ^b, Benjamin H. Kaffenberger, MD, MS ^c, Abraham M. Korman, MD ^c, Robert G. Micheletti, MD ^d, Arash Mostaghimi, MD, MPA, MPH ^e, Megan H. Noe, MD, MPH, MSCE ^e, Misha Rosenbach, MD ^d, Kanade Shinkai, MD, PhD ^b, Jason H. Kwah, MD, MSc ^f, Elizabeth J. Phillips, MD ^g, Jean L. Bolognia, MD ^a, William Damsky, MD, PhD ^a,^h, Caroline A. Nelson, MD ^a,^⁎
^a Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
^b Department of Dermatology, University of California, San Francisco, California
^c Department of Dermatology, The Ohio State University, Columbus, Ohio
^d Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^e Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
^f Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut
^g Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
^h Department of Pathology, Yale School of Medicine, New Haven, Connecticut

^∗Correspondence to: Caroline A. Nelson, MD, Department of Dermatology, Yale University School of Medicine, 15 York St, New Haven, CT 06510.Department of DermatologyYale University School of Medicine15 York StNew HavenCT06510

Abstract

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.

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Key words : 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

Abbreviations used : CYP, DiHS, DNA, DRESS, HHV, HLA, ICI, IL, IQR, SCAR, TCR, T-reg

Plan

Histopathological features

	Funding source: None.
	Patient consent: Consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and included at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available.
	IRB approval status: Not applicable.
	Date of release: May 2024.
	Expiration date: May 2027.