St George-Hyslop Frances, Cherepacha Nicole, Chugani Bindiya, Alabdeen Yousef, Sanchez-Espino Luis Fernando, Mahood Quenby, Sibbald Cathryn, Verstegen Ruud H J
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Clin Rev Allergy Immunol. 2024 Feb;66(1):112-123. doi: 10.1007/s12016-024-08983-7. Epub 2024 Mar 11.
Effective treatment of drug reactions with eosinophilia and systemic symptoms (DReSS) requires early diagnosis and close monitoring. Diagnosing DReSS is especially challenging in children due to a low incidence rate, heterogeneous clinical presentation, and a lack of (pediatric) diagnostic criteria and clinical practice guidelines. We performed a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to summarize the clinical presentation and diagnostic process of DReSS in children (aged 0-18 years). Data from 644 individuals showed that DReSS manifests differently in children compared to adults. Children have a higher number of organs involved, including higher rates of cardiac and respiratory involvement compared to adults. Children < 6 years of age appear more prone to develop neurologic symptoms. Conversely, eosinophilia, edema, and kidney involvement are less frequently observed in children. Anti-seizure medications are by far the most common causative drug class, but the range of implicated drugs increases as children get older. This study highlights that children with DReSS not only differ from adults but also that differences exist between children of different ages. As such, there is a need to establish pediatric-specific diagnostic criteria. These efforts will promote earlier diagnosis of DReSS and likely lead to improved clinical care offered to children and their families.
有效治疗药物反应伴嗜酸性粒细胞增多和全身症状（DReSS）需要早期诊断和密切监测。由于发病率低、临床表现异质性以及缺乏（儿科）诊断标准和临床实践指南，在儿童中诊断DReSS尤其具有挑战性。我们根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行了一项范围综述，以总结儿童（0至18岁）DReSS的临床表现和诊断过程。来自644名个体的数据表明，与成人相比，DReSS在儿童中的表现有所不同。儿童受累器官数量更多，与成人相比，心脏和呼吸系统受累率更高。6岁以下儿童似乎更容易出现神经症状。相反，儿童中嗜酸性粒细胞增多、水肿和肾脏受累的情况较少见。抗癫痫药物是迄今为止最常见的致病药物类别，但随着儿童年龄的增长，涉及的药物范围会增加。这项研究强调，患有DReSS的儿童不仅与成人不同，而且不同年龄段的儿童之间也存在差异。因此，有必要建立针对儿科的诊断标准。这些努力将促进DReSS的早期诊断，并可能改善为儿童及其家庭提供的临床护理。
