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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Eine Übersicht

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

A Review

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Zusammenfassung

Das DRESS („Drug Reaction with Eosinophilia and Systemic Symptoms“; syn.: Hypersensitivitätssyndrom) ist eine schwere, potenziell lebensbedrohliche Arzneimittelreaktion. Die Mortalität liegt bei 10 %; die Inzidenz ist weltweit zunehmend. Die häufigsten Auslöser sind aromatische Antikonvulsiva (Carbamazepin, Lamotrigin, Phenobarbital) und zunehmend moderne antiretrovirale Medikamente. Die Pathogenese ist nicht vollends geklärt, wahrscheinlich multifaktoriell mit Zusammentreffen von Immunreaktion, ethnischer Prädisposition, genetisch determiniertem Enzymmangel und Reaktivierung von Herpesviren (HHV-6, HHV-7, Epstein-Barr-Virus, Zytomegalievirus). Infolge Haut- und Multiorganbeteiligung ist das klinische Bild variabel, sodass kein eindeutiger klinischer, histologischer oder laborchemischer Phänotyp charakterisiert werden kann. Dies wird durch eine lange Latenz zwischen Beginn der Medikamenteneinnahme und Beginn des DRESS bzw. sukzessives Auftreten von Haut- und Organbeteiligung erschwert. Auch wenn oder gerade weil das DRESS eine diagnostische Herausforderung darstellt, ist eine genaue Kenntnis des Krankheitsbildes wichtig, um frühzeitig therapeutische Maßnahmen einleiten zu können.

Abstract

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), also known as hypersensitivity syndrome (HSS), is a severe and potentially life-threatening drug reaction. The worldwide rate of mortality is about 10 %, its incidence is increasing. Drugs that most frequently induce DRESS are aromatic anticonvulsive drugs (carbamazepine, lamotrigine, phenobarbital), and more recently new retroviral therapies. The pathogenesis of DRESS is not yet fully understood, but is certainly multifactorial involving a combination of immune reactions, ethnic predisposition, genetically determined enzyme deficiencies and reactivation of herpes viruses (HHV-6, HHV-7, EBV, CMV). Because of the involvement of the skin and internal organs, the clinical picture can be very variable. No specific clinical, histologic or laboratory parameter is available, so the diagnosis has to rely on the clinical appearance. The long latency period between start of drug intake and the initial manifestation of DRESS and the successive onset of skin and organ involvement complicates the early diagnosis. Although or even because DRESS represents a diagnostic challenge, detailed knowledge about this disease is of utmost importance to enable early therapeutic actions.

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Literatur

  1. An J, Lee JH, Lee H et al (2012) Drug rash with eosinophilia and systemic symptoms syndrome following cholestatic hepatitis A: a case report. Korean J Hepatol 18:84–88

    Article  PubMed  Google Scholar 

  2. Bocquet H, Bagot M, Roujeau JC (1996) Drug induced pseudolymphoma and drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms). Semin Cutan Med Surg 15:250–257

    Article  PubMed  CAS  Google Scholar 

  3. Halink DA, Marijnissen RM et al (2011) Drug reaction with eosinophilia and systemic symptoms induced by carbamazepine: DRESSed to kill. Gen Hosp Psychiatry 33:412

    Article  PubMed  Google Scholar 

  4. Shiohara T, Inaoka M, Kano Y (2006) Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpesviruses and antiviral and antidrug immune responses. Allergol Int 55:1–8

    Article  PubMed  Google Scholar 

  5. Shiohara T, Kano Y, Takahashi R et al (2012) Drug-induced hypersensitivity syndrome: recent advances in the diagnosis, pathogenesis and management. Chem Immunol Allergy 97:122–138

    Article  PubMed  Google Scholar 

  6. Giri PP, Roy S, Bhattyacharya S et al (2011) Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum. Indian J Dermatol 56:763–765

    Article  PubMed  Google Scholar 

  7. Bauer KA, Brimhall AK, Chang TT (2011) Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with azithromycin in acute Epstein-Barr virus infection. Pediatr Dermatol 28:741–743

    Article  PubMed  Google Scholar 

  8. Shiohara T, Kano Y (2007) A complex interaction between drug allergy and viral infection. Clin Rev Allergy Immunol 33:124–133

    Article  PubMed  CAS  Google Scholar 

  9. Kardaun SH, Sidoroff A, Valeyrie-Allanore L et al (2007) Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: Does a DRESS syndrome really exist? Br J Dermatol 156:609–611

    Article  PubMed  CAS  Google Scholar 

  10. Walsh S, Diaz-Cano S, Higgins E et al (2013) Drug reaction with eosinophilia and systemic symptoms: Is cutaneous phenotype a prognostic marker for outcome? A review of clinicopathological features of 27 cases. Br J Dermatol 168:391–401

    Article  PubMed  CAS  Google Scholar 

  11. Gómez-Zorrilla S, Ferraz AV, Pedrós C et al (2012) Levetiracetam-induced drug reaction with eosinophilia and systemic symptoms syndrome. Ann Pharmacother 46:e20

    Article  PubMed  Google Scholar 

  12. Mockenhaupt M (2009) Severe drug-induced skin reactions: clinical pattern, diagnostics and therapy. J Dtsch Dermatol Ges 7:142–160

    PubMed  Google Scholar 

  13. Criado PR, Criado RF, Avancini Jde M et al (2012) Drug reaction with eosinophilia and systemic symptoms (DRESS)/drug-induced hypersensitivity syndrome (DIHS): a review of current concepts. An Bras Dermatol 87:435–449

    Article  PubMed  Google Scholar 

  14. Kong Q, Sang H, Zhang M et al (2012) Rhabdomyolysis associated with roxithromycin hypersensitivity syndrome. Indian J Dermatol Venereol Leprol 78:197–199

    PubMed  Google Scholar 

  15. Müller PA, Amann K, Bröcker EB et al (2012) Maculo-papular exanthem with acute renal failure. Drug-induced hypersensitivity syndrome. Hautarzt 63:223–255

    Article  PubMed  Google Scholar 

  16. Ang CC, Wang YS, Yoosuff EL et al (2010) Retrospective analysis of drug-induced hypersensitivity syndrome: a study of 27 patients. J Am Acad Dermatol 63:219–227

    Article  PubMed  Google Scholar 

  17. Lehmann P, Hartung W, Fleck M (2013) Rhabdomyolysis and creatine kinase elevation. Z Rheumatol 72:236–241

    Article  PubMed  CAS  Google Scholar 

  18. Ogawa K, Morito H, Hasegawa A et al (2013) Identification of thymus and activation-regulated chemokine (TARC/CCL17) as a potential marker for early indication of disease and prediction of disease activity in drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS). J Dermatol Sci 69(1):38–43

    Article  PubMed  CAS  Google Scholar 

  19. Ganeva M, Gancheva T, Lazarova R et al (2008) Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: report of four cases and brief review. Int J Dermatol 47:853–860

    Article  PubMed  Google Scholar 

  20. Cacoub P, Musette P, Descamps V et al (2011) The DRESS syndrome: a literature review. Am J Med 124:588–597

    Article  PubMed  CAS  Google Scholar 

  21. Bensaid B, Rozieres A, Nosbaum A et al (2012) Amikacin-induced drug reaction with eosinophilia and systemic symptoms syndrome: delayed skin test and ELISPOT assay results allow the identification of the culprit drug. J Allergy Clin Immunol 130:1413–1414

    Article  PubMed  CAS  Google Scholar 

  22. Kang SY, Kim JY, Kim MY et al (2012) Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms syndrome induced by cilostazol and carbamazepine. J Dermatol 39:723–724

    Article  PubMed  Google Scholar 

  23. Loulergue P, Mir O (2012) Raltegravir-induced DRESS syndrome. Scand J Infect Dis 44:802–803

    Article  PubMed  Google Scholar 

  24. Roujeau JC, Mockenhaupt M, Tahan SR et al (2013) Telaprevir-related dermatitis. JAMA Dermatol 149:152–158

    Article  PubMed  Google Scholar 

  25. Bayonne Kombo ES, Gathse A (2013) Tenofovir hypersensitivity to tenofovir (DRESS) syndrome in a female patient infected by HIV. Med Mal Infect 43:134–135

    Article  Google Scholar 

  26. Rawlins MD, Thompson JW (1977) Pathogenesis of adverse drug reactions. In: Davies DM (Hrsg) Textbook of adverse drug reactions. Oxford University Press, Oxford, S 10

  27. Hausmann O, Schnyder B, Pichler WJ (2012) Etiology and pathogenesis of adverse drug reactions. Chem Immunol Allergy 97:32–46

    Article  PubMed  CAS  Google Scholar 

  28. Takahashi R, Kano Y, Yamazaki Y et al (2009) Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. J Immunol 182:8071–8079

    Article  PubMed  CAS  Google Scholar 

  29. Camous X, Calbo S, Picard D et al (2012) Drug reaction with eosinophilia and systemic symptoms: an update on pathogenesis. Curr Opin Immunol 24:730–735

    Article  PubMed  CAS  Google Scholar 

  30. Bohan KH, Mansuri TF, Wilson NM (2007) Anticonvulsant hypersensitivity syndrome: implications for pharmaceutical care. Pharmacotherapy 27:1425–1439

    Article  PubMed  CAS  Google Scholar 

  31. Tohyama M, Hashimoto K, Yasukawa M et al (2007) Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome. Br J Dermatol 157:934–940

    Article  PubMed  CAS  Google Scholar 

  32. Barbaud A, Waton J, Herbeth B et al (2013) Comparison of cytokine gene polymorphism in drug-induced maculopapular eruption, urticaria and drug reaction with eosinophilia and systemic symptoms (DRESS). J Eur Acad Dermatol Venereol [Epub ahead of print]

  33. Ostrov DA, Grant BJ, Pompeu YA et al (2012) Drug hypersensitivity caused by alteration of the MHC-presented self-peptide repertoire. Proc Natl Acad Sci U S A 109:9959–9964

    Article  PubMed  CAS  Google Scholar 

  34. Norcross MA, Luo S, Lu L et al (2012) Abacavir induces loading of novel self-peptides into HLA-B*57: 01: an autoimmune model for HLA-associated drug hypersensitivity. AIDS 26:21–29

    Article  Google Scholar 

  35. Saag M, Balu R, Phillips E et al (2008) Study of Hypersensitivity to Abacavir and Pharmacogenetic Evaluation Study Team. High sensitivity of human leukocyte antigen-b*5701 as a marker for immunologically confirmed abacavir hypersensitivity in white and black patients. Clin Infect Dis 46:1111–1118

    Article  PubMed  CAS  Google Scholar 

  36. Pirmohamed M (2012) Genetics and the potential for predictive tests in adverse drug reactions. Chem Immunol Allergy 97:18–31

    Article  PubMed  CAS  Google Scholar 

  37. Profaizer T, Eckels D (2012) HLA alleles and drug hypersensitivity reactions. Int J Immunogenet 39:99–105

    Article  PubMed  CAS  Google Scholar 

  38. http://www.pei.de/cln_236/nn_154420/SharedDocs/Downloads/vigilanz/bulletin-zur-arzneimittelsicherheit/2012/2-2012,templateId=raw, property=publicationFile.pdf/2-2012.pdf

  39. Neuman MG, Cohen L, Nanau RM et al (2012) Genetic and immune predictors for hypersensitivity syndrome to antiepileptic drugs. Transl Res 159:397–406

    Article  PubMed  CAS  Google Scholar 

  40. Chiu ML, Hu M, Ng MH et al (2012) Association between HLA-B*58:01 allele and severe cutaneous adverse reactions with allopurinol in Han Chinese in Hong Kong. Br J Dermatol 167:44–49

    Article  PubMed  CAS  Google Scholar 

  41. Phillips EJ, Chung WH, Mockenhaupt M et al (2011) Drug hypersensitivity: pharmacogenetics and clinical syndromes. J Allergy Clin Immunol 127:60–66

    Article  Google Scholar 

  42. (o A) (2008) „Quality assurance in the lymphocyte transformation test“ – addendum to the LTT publication „Methods and quality assurance in environmental medicine“ by the RKI Committee. „Methods and quality assurance in environmental medicine“ report by the committee. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51:1070–1076

  43. Descamps V, Ben-Saïd B, Sassolas B et al (2010) Management of drug reaction with eosinophilia and systemic symptoms (DRESS). Ann Dermatol Venereol 137:703–708

    Article  PubMed  CAS  Google Scholar 

  44. Moling O, Tappeiner L, Piccin A et al (2012) Treatment of DIHS/DRESS syndrome with combined N-acetylcysteine, prednisone and valganciclovir – a hypothesis. Med Sci Monit 18:57–62

    Article  Google Scholar 

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Finanzierung

Der Beitrag wurde bei dem Derma Update 2012 präsentiert.

Interessenkonflikt

S. Ständer, D. Metze, T. Luger und T. Schwarz geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland

    S. Ständer, D. Metze & T. Luger

  2. Klinik für Hautkrankheiten, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    T. Schwarz

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  1. S. Ständer
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  2. D. Metze
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Correspondence to S. Ständer.

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Ständer, S., Metze, D., Luger, T. et al. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Hautarzt 64, 611–624 (2013). https://doi.org/10.1007/s00105-013-2615-0

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  • DOI: https://doi.org/10.1007/s00105-013-2615-0

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