title: Drug-reaction eosinophilia and systemic symptoms and drug-induced hypersensitivity syndrome.
abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), is a rare, severe cutaneous adverse reaction characterised by fever, rash, lymphadenopathy, eosinophilia and/or other leukocyte abnormalities, and internal organ involvement and often has a relapsing-remitting course despite withdrawal of the drug. The drugs that are most implicated include aromatic anticonvulsants, allopurinol, sulphonamides, antiretrovirals (abacavir and nevirapine), and minocycline. The pathogenesis of DRESS/DIHS is far from clear but probably involves a combination of impaired pharmacokinetics and the accumulation of drug metabolites, the sequential reactivation of the herpesvirus family and genetic susceptibility conferred by the association with certain human leukocyte antigen (HLA) class I alleles. The strong association between abacavir and HLA-B*5701 has enabled pharmacogenetics screening to be employed successfully to minimise the occurrence of hypersensitivity. A prolonged course of oral corticosteroids is required to treat DRESS/DIHS, given the relapsing-remitting nature of the condition with i.v. immunoglobulin and valgangciclovir reserved for refractory or life-threatening cases.
authors.affiliation: Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; PaLMS Immunorheumatology Laboratory, Sydney, Australia; Sydney Medical School-Northern, Sydney University, Sydney, Australia.
authors.forename: Suran L
authors.initials: SL
authors.lastname: Fernando
mesh_terms: D000493:Allopurinol / Q000009:adverse effects; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000235:genetics / Q000628:therapy; D015395:Histocompatibility Antigens Class I / Q000235:genetics*; D006801:Humans; D008911:Minocycline / Q000009:adverse effects; D013449:Sulfonamides / Q000009:adverse effects
chemical_list: D044966:Anti-Retroviral Agents; D000927:Anticonvulsants; D015395:Histocompatibility Antigens Class I; D013449:Sulfonamides; D000493:Allopurinol; D008911:Minocycline
keywords: DIHS; DRESS; abacavir hypersensitivity; anticonvulsant hypersensitivity syndrome; drug allergy; drug hypersensitivity; drug-induced hypersensitivity syndrome; drug-reaction eosinophilia and systemic symptoms; pharmacogenetics; severe cutaneous adverse reaction