Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Hospital, Heidelberg, VIC, Australia.
Department of Dermatology, Austin Health, Heidelberg, VIC, Australia.
J Allergy Clin Immunol Pract. 2023 Jun;11(6):1856-1868. doi: 10.1016/j.jaip.2023.02.035. Epub 2023 Mar 7.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening drug reaction; recognizing the diversity of its clinical presentations, implicated drugs, and management modalities can aid in diagnosis and reduce morbidity and mortality.
To review the clinical features, drug causes, and treatments deployed in DRESS.
This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to review publications relating to DRESS published between 1979 and 2021. Only publications with a RegiSCAR score of 4 or greater were included (indicating "probable" or "definite" DRESS). The PRISMA guidelines were used for data extraction and the Newcastle-Ottawa scale for quality assessment (Pierson DJ. Respir Care 2009;54:1372-8). The main outcomes included implicated drugs, patient demographics, clinical manifestations, treatment, and sequelae for each included publication.
A total of 1124 publications were reviewed, and 131 met the inclusion criteria, amounting to 151 cases of DRESS. The most implicated drug classes were antibiotics, anticonvulsants, and anti-inflammatories, although up to 55 drugs were implicated. Cutaneous manifestations were present in 99% of cases, with a median onset of 24 days and maculopapular rash the most common morphology. Common systemic features were fever, eosinophilia, lymphadenopathy, and liver involvement. Facial edema was present in 67 cases (44%). Systemic corticosteroids were the mainstay of DRESS-specific treatment. A total of 13 cases (9%) resulted in mortality.
DRESS diagnosis should be considered in the presence of a cutaneous eruption, fever, eosinophilia, liver involvement, and lymphadenopathy. The class of implicated drug may influence outcome, as allopurinol was associated with 23% of cases that resulted in death (3 cases). Given potential DRESS complications and mortality, it is important that DRESS is recognized early so that any suspect drugs are ceased promptly.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种潜在的危及生命的药物反应；认识其临床表现、相关药物和治疗方式的多样性有助于诊断，并降低发病率和死亡率。
回顾 DRESS 的临床特征、药物病因和治疗方法。
本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行，以审查 1979 年至 2021 年间发表的与 DRESS 相关的出版物。仅纳入 RegiSCAR 评分为 4 或更高的出版物（表示“可能”或“明确”的 DRESS）。使用 PRISMA 指南进行数据提取和纽卡斯尔-渥太华量表进行质量评估（Pierson DJ. Respir Care 2009;54:1372-8）。主要结局包括纳入的每篇出版物中涉及的药物、患者人口统计学、临床表现、治疗和后遗症。
共审查了 1124 篇出版物，其中 131 篇符合纳入标准，共 151 例 DRESS。最常见的药物类别是抗生素、抗惊厥药和抗炎药，尽管有多达 55 种药物涉及。99%的病例存在皮肤表现，中位发病时间为 24 天，最常见的形态为斑丘疹。常见的全身特征包括发热、嗜酸性粒细胞增多、淋巴结病和肝脏受累。面部水肿见于 67 例（44%）。全身性皮质类固醇是 DRESS 特异性治疗的主要药物。共有 13 例（9%）导致死亡。
在存在皮疹、发热、嗜酸性粒细胞增多、肝脏受累和淋巴结病时，应考虑 DRESS 诊断。涉及的药物类别可能影响预后，因为别嘌呤醇与导致死亡的病例（3 例）占 23%。鉴于潜在的 DRESS 并发症和死亡率，早期识别 DRESS 非常重要，以便迅速停止任何可疑药物。
