Interleukin(IL)-1/IL-6-inhibitor-associated drug reaction with eosinophilia and systemic symptoms (DReSS) in systemic inflammatory illnesses.

Still disease biologic therapy drug reaction with eosinophilia and systemic symptoms drug-induced lung disease hemophagocytic lymphohistiocytosis macrophage activation syndrome pulmonary hypertension systemic inflammatory illnesses

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:
11 Jul 2024

Historique:

received: 06 03 2024

revised: 30 05 2024

accepted: 02 07 2024

medline: 14 7 2024

pubmed: 14 7 2024

entrez: 13 7 2024

Statut: aheadofprint

Résumé

After introducing interleukin(IL)-1/IL-6 inhibitors, some Still and Still-like patients developed unusual often fatal pulmonary disease. This complication was associated with scoring as DReSS (drug reaction with eosinophilia and systemic symptoms) implicating these inhibitors, although DReSS can be difficult to recognize in the setting of systemic inflammatory disease. We sought to facilitate recognition of IL-1/IL-6 inhibitor-DReSS in systemic inflammatory illnesses (Still/Still-like) by looking at timing and reaction-associated features. We evaluated outcomes of stopping or not-stopping IL-1/IL-6-inhibitors after DReSS reaction began. In an international study collaborating primarily with pediatric specialists, we characterized features of 89 drug-reaction cases versus 773 drug-exposed controls and compared outcomes of 52 cases stopping IL-1/IL-6-inhibitors to 37 cases not-stopping these drugs. Before reaction began, drug-reaction cases and controls were clinically comparable, except for younger disease onset age for reaction cases with pre-existing cardiothoracic comorbidities. After reaction began, increased rates of pulmonary complications and macrophage activation syndrome (MAS), differentiated drug-reaction cases from drug-tolerant controls (p=4.7x10 In systemic inflammatory illnesses, recognition of IL-1/IL-6-inhibitor-associated reactions followed by avoidance of IL-1/IL-6-inhibitors significantly improved outcomes.

Sections du résumé

BACKGROUND BACKGROUND

OBJECTIVE OBJECTIVE

We sought to facilitate recognition of IL-1/IL-6 inhibitor-DReSS in systemic inflammatory illnesses (Still/Still-like) by looking at timing and reaction-associated features. We evaluated outcomes of stopping or not-stopping IL-1/IL-6-inhibitors after DReSS reaction began.

METHODS METHODS

In an international study collaborating primarily with pediatric specialists, we characterized features of 89 drug-reaction cases versus 773 drug-exposed controls and compared outcomes of 52 cases stopping IL-1/IL-6-inhibitors to 37 cases not-stopping these drugs.

RESULTS RESULTS

Before reaction began, drug-reaction cases and controls were clinically comparable, except for younger disease onset age for reaction cases with pre-existing cardiothoracic comorbidities. After reaction began, increased rates of pulmonary complications and macrophage activation syndrome (MAS), differentiated drug-reaction cases from drug-tolerant controls (p=4.7x10

CONCLUSIONS CONCLUSIONS

In systemic inflammatory illnesses, recognition of IL-1/IL-6-inhibitor-associated reactions followed by avoidance of IL-1/IL-6-inhibitors significantly improved outcomes.

Identifiants

DOI: 10.1016/j.jaip.2024.07.002 PMID: 39002722

pubmed: 39002722

pii: S2213-2198(24)00692-5

doi: 10.1016/j.jaip.2024.07.002

pii:

doi:

Types de publication

Journal Article

Langues

eng

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K Abulaban (K)

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C Aguiar Lapsia (CA)

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S Akoghlanian (S)

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