Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2019 Feb;7(2):633-640. doi: 10.1016/j.jaip.2018.08.013. Epub 2018 Aug 31.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe hypersensitivity reaction that remains poorly characterized in the United States.
To identify and describe DRESS syndrome cases in an integrated health care system using electronic health record (EHR) allergy module free-text searches.
We identified DRESS syndrome cases with rash, absolute eosinophil count of 500/L or more, organ involvement, and a European Registry of Severe Cutaneous Adverse Reactions to Drugs and Collection of Biological Samples score of 2 or more by reviewing those patients from 1980 to 2016 whose EHR allergic reaction matched DRESS-related key words. Liver injury required alanine aminotransferase level of 100 U/L or more, and renal injury required creatinine increase by 0.5 mg/dL (or 50%) or more. Patient and DRESS characteristics were described, resource use was determined, and cost was estimated.
Among 3,162,562 patients with 3,319,387 million allergy entries, 538 reactions matched key words, and 69 were DRESS syndrome cases (prevalence 2.18 per 100,000). Patients with DRESS had liver (42%) or renal (42%) injury; 11 (16%) had both liver and renal injury. Primary drug culprits were antibiotics (74%) (vancomycin [39%], β-lactams [23%], fluoroquinolones [4%], tetracyclines [4%], and sulfonamides [3%]) and anticonvulsants (20%). Of 65 (94%) hospitalized patients with DRESS, 43 (66%) were hospitalized for DRESS syndrome management with median length of stay of 9 days (interquartile range, 6-17 days) and cost approximately $17,101 per patient.
Using free-text search of the EHR allergy module identified a large US DRESS syndrome cohort. DRESS prevalence was 2.18 per 100,000 patients. Both liver and kidney injury were frequent, and vancomycin was the most common drug culprit. DRESS cases were morbid and resource-intensive.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种罕见但严重的超敏反应，在美国的特征仍不清楚。
使用电子健康记录（EHR）过敏模块的自由文本搜索，在综合医疗保健系统中识别和描述 DRESS 综合征病例。
我们通过回顾 1980 年至 2016 年期间 EHR 过敏反应与 DRESS 相关关键词匹配的患者，确定了符合皮疹、嗜酸性粒细胞绝对计数 500/L 或以上、器官受累和欧洲严重皮肤不良反应药物登记处和生物样本收集评分 2 或以上的 DRESS 综合征病例。肝损伤需要丙氨酸氨基转移酶水平 100 U/L 或以上，肾损伤需要肌酐增加 0.5mg/dL（或 50%）或以上。描述了患者和 DRESS 特征，确定了资源使用情况，并估算了成本。
在 3162562 名患者的 3319387 百万过敏条目记录中，有 538 次反应与关键词匹配，有 69 例为 DRESS 综合征病例（每 100000 人 2.18 例）。DRESS 患者有肝脏（42%）或肾脏（42%）损伤；11 例（16%）有肝肾功能损伤。主要药物罪魁祸首是抗生素（74%）（万古霉素[39%]、β-内酰胺类抗生素[23%]、氟喹诺酮类[4%]、四环素类[4%]和磺胺类[3%]）和抗惊厥药（20%）。在 65 名（94%）住院 DRESS 患者中，43 名（66%）因 DRESS 综合征管理住院，中位住院时间为 9 天（四分位距，6-17 天），每位患者的费用约为 17101 美元。
使用 EHR 过敏模块的自由文本搜索确定了一个大型美国 DRESS 综合征队列。DRESS 的患病率为每 100000 名患者 2.18 例。肝脏和肾脏损伤均很常见，万古霉素是最常见的药物罪魁祸首。DRESS 病例病情严重，资源消耗大。
