R Cabañas1,2,3,4, E Ramírez2,3,5, E Sendagorta3,6, R Alamar7, R Barranco3,8,9, N Blanca-López10, I Doña11,12, J Fernández13, I Garcia-Nunez14, J García-Samaniego15, R Lopez-Rico16, E Marín-Serrano17, C Mérida18, M Moya19, N R Ortega-Rodríguez20, B Rivas Becerra2,21, P Rojas-Perez-Ezquerra3,22, M J Sánchez-González3,23, C Vega-Cabrera2,21, C Vila-Albelda24, T Bellón2,3,25. 1. Allergy Unit, Hospital Universitario La Paz, Madrid, Spain. 2. Institute for Health Research (IdiPAZ), Madrid, Spain. 3. PIELenRed Consortium. 4. Centro de Investigación en Red de Enfermedades Raras (CIBERER, U754). 5. Pharmacology Department La Paz University Hospital, Madrid, Spain; PIELenRed Consortium. 6. Dermatology Department La Paz University Hospital. 7. Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain. 8. Allergy Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. 9. ARADyAL. 10. Allergy Service, Infanta Leonor University Hospital, Madrid, Spain. 11. Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain. 12. Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain. 13. Allergy Section, Alicante University Hospital, ISABIAL-UMH, Alicante, Spain. 14. Allergy and Pneumology Department, Hospital Quironsalud Campo de Gibraltar, Los Barrios (Cádiz), Spain. 15. Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Madrid, Spain. 16. Allergy Department, Hospital Universitario de A Coruña, A Coruña, Spain. 17. Gastroenterology Department La Paz University Hospital, Madrid, Spain. 18. Allergy Unit, Hospital Clínico San Cecilio, Granada, Spain. 19. Allergy Unit, Hospital Universitario Torrecárdenas, Almería, Spain. 20. Allergy Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain. 21. Nephrology Department, La Paz University Hospital, Madrid, Spain. 22. Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 23. Allergy Department, Príncipe de Asturias University Hospital, Alcalá de Henares. Madrid, Spain. 24. Allergy Unit, "Severo Ochoa" University Hospital, Leganés, Madrid, Spain. 25. Drug Hypersensitivity Laboratory, La Paz Hospital, Madrid, Spain.
Abstract
BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.
BACKGROUND AND OBJECTIVE:Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.
Entities:
Keywords:
Corticosteroids; DRESS syndrome; Drug reaction with eosinophilia and systemic symptoms; Drug-induced hypersensitivity syndrome; Lymphocyte transformation test; Patch tests; SCAR; Skin tests