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Risk factors associated with DRESS syndrome produced by aromatic and non-aromatic antipiletic drugs

  • Pharmacodynamics
  • Published:
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Abstract

Purpose

DRESS (drug reaction with eosinophilia and systemic symptoms) is an idiosyncratic entity associated with the use of drugs. Its pathophysiology is not known, but is associated with immunological or genetic factors. The incidence is 0.4 cases per 1,000,000 general population. The syndrome usually develops at the beginning of treatment and is characterized by the presence of rash, fever, eosinophilia and systemic manifestations. The aim of our study was to describe the clinical manifestation and treatment of patients with DRESS associated with antiepileptic drugs (AEDs).

Methods

This is a descriptive study with the aim of describing the clinical manifestation and treatment associated with DRESS produced by aromatic and non-aromatic AEDs.

Results

Eight patients treated with AEDs developed DRESS between January 2007 and May 2010 at our hospital. All had dermatological manifestations, eosinophilia and systemic (haematological and hepatic) manifestations that could be attributed to treatment with aromatic AEDs (carbamazepine, 2 patients; lamotrigine, 3 patients; phenytoin, 3 patients). Therapeutic management included removal of the drug from the therapeutic regime, symptomatic management, life support and use of corticosteroids. There was no mortality associated with the syndrome. Reversion of systemic manifestations was very slow: between 1 and 6 months.

Conclusions

DRESS is a severe cutaneous reaction, with high morbidity and mortality, whose development seems to be associated with individual susceptibility, type of antiepileptic drug used (more common with aromatic drugs), titration rate and concomitant medications.

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Abbreviations

ADRs:

Adverse drug reactions

AEDs:

Antiepileptic drugs

CBZ:

Carbamazepine

DPH:

Phenytoin

DRESS:

Drug reaction with eosinophilia and systemic symptoms

HHV 6:

Human herpes virus 6

HHV 7:

Human herpes virus 7

LMT:

Lamotrigine

OXC:

Oxcarbacepine

Pb:

Phenobarbital

SCARs:

Severe cutaneous adverse reactions

VPA:

Valproic acid

TPM:

Topiramate

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Acknowledgments

Nation Health Ministry. National Commission “Salud Investiga”.

Buenos Aires University. Medicine School.

Conflict of interest

None.

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Authors and Affiliations

  1. Epilepsy Section, Neurology Division, José María Ramos Mejía Hospital, Urquiza 609 (1221), Buenos Aires, Argentina

    Nahuel Pereira de Silva, Paulo Piquioni, Silvia Kochen & Patricia Saidon

Authors
  1. Nahuel Pereira de Silva
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  2. Paulo Piquioni
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  3. Silvia Kochen
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  4. Patricia Saidon
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Correspondence to Nahuel Pereira de Silva.

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Pereira de Silva, N., Piquioni, P., Kochen, S. et al. Risk factors associated with DRESS syndrome produced by aromatic and non-aromatic antipiletic drugs. Eur J Clin Pharmacol 67, 463–470 (2011). https://doi.org/10.1007/s00228-011-1005-8

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