Drug-Induced Hypersensitivity Syndrome (DIHS)/Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): Clinical Features and Pathogenesis.
Autoimmune
CMV
Corticosteroids
DIHS
DRESS
EBV
Eosinophilia
HHV-6
HLA
Hypersensitivity
Journal
The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
25
10
2021
revised:
07
02
2022
accepted:
07
02
2022
pubmed:
18
2
2022
medline:
11
5
2022
entrez:
17
2
2022
Statut:
ppublish
Résumé
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is one example of a severe delayed T-cell-mediated adverse drug reaction. DIHS/DRESS presents with fever, widespread rash and facial edema, organ involvement, and hematological abnormalities, including eosinophilia and atypical lymphocytosis. DIHS/DRESS is associated with relapse 2 to 4 weeks after acute symptoms, often coinciding with reactivation of prevalent chronic persistent human herpesviruses such as human herpesvirus 6, EBV, and cytomegalovirus. The mortality of DIHS/DRESS is up to 10% and often related to unrecognized myocarditis and cytomegalovirus complications, with longer-term consequences that contribute to morbidity including autoimmune diseases such as thyroiditis. It is essential that all potential drug causes, including all new drugs introduced within the 8 weeks preceding onset of DIHS/DRESS symptoms, are identified. All potential drug culprits, as well as drugs that are closely related structurally to the culprit drug, should be avoided in the future. Systemic corticosteroids have remained the mainstay for the treatment of DIHS/DRESS with internal organ involvement. Steroid-sparing agents, such as cyclosporine, mycophenolate mofetil, and monthly intravenous immune globulin, have been successfully used for treatment, and careful follow-up for cytomegalovirus reactivation is recommended. Strong associations between HLA class I alleles and DIHS/DRESS predisposition include HLA-B∗13:01 and dapsone, HLA-B∗58:01 and allopurinol, and HLA-B∗32:01 and vancomycin. These have opened a pathway for prevention, risk stratification, and earlier diagnosis. Single-cell sequencing and other studies of immunopathogenesis promise to identify targeted treatment approaches.
Identifiants
pubmed: 35176506
pii: S2213-2198(22)00126-X
doi: 10.1016/j.jaip.2022.02.004
pmc: PMC9201940
mid: NIHMS1809245
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1155-1167.e5Subventions
Organisme : NIGMS NIH HHS
ID : P50 GM115305
Pays : United States
Organisme : NHGRI NIH HHS
ID : R01 HG010863
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI152183
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI154659
Pays : United States
Organisme : NIAMS NIH HHS
ID : R13 AR078623
Pays : United States
Informations de copyright
Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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