Stirton Hannah, Shear Neil H, Dodiuk-Gad Roni P
Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB R2M 3Y8, Canada.
Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada.
Biomedicines. 2022 Apr 26;10(5):999. doi: 10.3390/biomedicines10050999.
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.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DReSS），也称为药物性超敏综合征（DiHS），是一种严重的、全身性的、T细胞介导的药物反应，伴有皮肤、血液学和内脏器官受累。DReSS的发病机制是多因素的，涉及药物暴露、通过特定人类白细胞抗原（HLA）等位基因和代谢缺陷的遗传易感性、病毒再激活和免疫失调。这种疾病的临床特征是延迟出现、逐步发展且具有异质性，这使得该综合征的识别和诊断具有挑战性。现有两套经过验证的诊断标准可用于诊断DReSS/DiHS。提高DReSS早期识别和预测疾病严重程度的方法是最近的研究重点领域。体外和体内试验可用于确诊并帮助确定致病药物。DReSS的主要治疗方法是迅速停用致病药物，根据疾病严重程度进行支持性治疗和免疫抑制。我们对DReSS的最新研究和文献进行了全面综述，重点关注发病机制、临床特征、诊断、确证检测方法和治疗。此外，本综述旨在突出对这种严重疾病的不同观点，并拓宽我们对DReSS这种疾病的认识。
