title: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A National Analysis of Data from 10-Year Post-marketing Surveillance.
abstract: BACKGROUND
  Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, severe and potentially fatal cutaneous adverse drug reaction (the mortality rate is up to 10 %) associated with numerous and apparently heterogeneous drugs. The aetiology is unknown.
  
  
  OBJECTIVE
  To report Italian cases of DRESS over a 10-year period.
  
  
  METHODS
  We searched the National Pharmacovigilance Network (NPN) for the term 'drug reaction with eosinophilia and systemic symptoms' from 1 January 2004 to 1 January 2014, to identify all reports of DRESS. Each case was checked to avoid duplication.
  
  
  RESULTS
  In the NPN, we identified 91 serious cases of DRESS: 68 were spontaneous, still-unpublished reports, while 23 additional cases were derived from screening of the scientific literature, performed by marketing authorization holders. Notably, the single common element linking all cases of DRESS was intake of a drug containing an aromatic ring.
  
  
  CONCLUSIONS
  Thanks to the largest national DRESS case series ever reported, we were able to hypothesize, for the first time, that there is an association between use of drugs containing an aromatic ring in their chemical structure and DRESS. This might aid understanding of the aetiology of DRESS and facilitate diagnosis.
authors.affiliation: Italian Medicines Agency, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Renda
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. landoni.giovanni@hsr.it.|Vita-Salute San Raffaele University, Milan, Italy. landoni.giovanni@hsr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Italian Medicines Agency, Rome, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Bertini Malgarini
authors.affiliation: Italian Medicines Agency, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Assisi
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Azzolini
authors.affiliation: IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Mucchetti
authors.affiliation: Italian Medicines Agency, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pimpinella
authors.affiliation: Italian Medicines Agency, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pani
mesh_terms: D000328:Adult; D000368:Aged; D063926:Drug Hypersensitivity Syndrome / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000737:chemistry*; D011358:Product Surveillance, Postmarketing; D012307:Risk Factors
chemical_list: D004364:Pharmaceutical Preparations