title: Drug Reaction with Eosinophilia and Systemic Symptoms: Retrospective Analysis of 104 Cases over One Decade.
abstract: BACKGROUND
  Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, life-threatening disorder caused by drugs. In the present study, we tried to explore the types of DRESS-inducing drugs, incubation period, features of skin rashes, accompanying visceral damage, and effectiveness of glucocorticoid therapy so as to inform clinical practice.
  
  
  METHODS
  Patients diagnosed with a drug-induced rash, dermatitis, and DRESS admitted to our hospital from January 2006 to December 2015 were included in the study. The diagnosis followed the criteria and scoring system set by the European Registry of Severe Cutaneous Adverse Reactions. Statistical analyses were carried out using SPSS version 17.0 (IBM, Armonk, NY, USA), and a value of P < 0.05 was considered statistically significant.
  
  
  RESULTS
  Among 104 patients, 38 were male and 66 female (aged 18-83 years). The latent period was 13 (interquartile range [IQR]: 10-17) days. The most common allergy-inducing drugs were antibiotics (n = 37, 35.6%), followed by antiepileptic drugs and traditional Chinese medicines (TCMs). Eighty-two cases (78.8%) had rash with area >50% body surface area (BSA). Liver damage occurred in 90% of cases. Patients were divided into oral antihistamine group and glucocorticoid/immunosuppressive agent/intravenous immunoglobulin (IVIG) group. Sex, age, incubation period, duration of hospital stay, and the number of patients with body temperature ≥38.5°C were not significantly different between the two groups. However, the number of patients meeting the criteria of "definite" and "probable" (χ2 = 5.852, P = 0.016), with an eosinophilic granulocyte count of ≥1.5 × 109/L (χ2 = 7.129, P = 0.008), and with rash area of >50% BSA (χ2 = 4.750, P = 0.029), was significantly different.
  
  
  CONCLUSIONS
  Antibiotics were associated with allergic reactions, but TCMs also had an important role. Allergy resulting from repeat use of the same drug was more severe with a shorter incubation period. The most typical rash was widespread erythematous papules. Liver damage accounted for >90% of cases.
authors.affiliation: Department of Dermatology, Allergy and Clinical Immunology Centre, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Dermatology, Allergy and Clinical Immunology Centre, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Xue-Ling
authors.initials: XL
authors.lastname: Mei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D003872:Dermatitis / Q000175:diagnosis / Q000209:etiology; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology*; D004802:Eosinophilia / Q000175:diagnosis* / Q000209:etiology*; D005076:Exanthema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008099:Liver / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents