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Clinical Presentation and Diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review

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Abstract

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.

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Data Availability

The data that support the findings of this study are available from the corresponding author (RV), upon reasonable request.

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Acknowledgements

The authors are grateful for library support by Catharine Pajunen and Jessie Cunningham (The Hospital for Sick Children, Toronto, Canada). In addition, we would like to thank Dr. Kimitaka Takitani (Osaka Medical and Pharmaceutical University, Department of Pediatrics, Japan) and Dr. Toshihiro Tanaka (Shizuoka Welfare Hospital, Japan) for providing publications for review.

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Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Frances St George-Hyslop & Nicole Cherepacha

  2. Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Frances St George-Hyslop, Nicole Cherepacha, Bindiya Chugani & Ruud H.J. Verstegen

  3. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Yousef Alabdeen, Cathryn Sibbald & Ruud H.J. Verstegen

  4. Division of Dermatology, Department of Paediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada

    Luis Fernando Sanchez-Espino

  5. Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada

    Luis Fernando Sanchez-Espino

  6. Hospital Library, The Hospital for Sick Children, Toronto, ON, Canada

    Quenby Mahood

  7. Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Cathryn Sibbald

  8. Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Ruud H.J. Verstegen

Authors
  1. Frances St George-Hyslop
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  2. Nicole Cherepacha
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  3. Bindiya Chugani
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  6. Quenby Mahood
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  7. Cathryn Sibbald
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  8. Ruud H.J. Verstegen
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Contributions

F.S., N.C., Y.A., L.S., and Q.M. performed the data collection. F.S. analyzed the data and prepared the draft manuscript. C.S. and R.V. supervised the project and edited the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Ruud H.J. Verstegen.

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St George-Hyslop, F., Cherepacha, N., Chugani, B. et al. Clinical Presentation and Diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review. Clinic Rev Allerg Immunol 66, 112–123 (2024). https://doi.org/10.1007/s12016-024-08983-7

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