Drug Reaction with Eosinophilia and Systemic Symptoms: A Review of Treatment Options
Main Article Content
Keywords
Drug reaction with eosinophilia and systemic symptoms, DRESS, treatment, supportive care, systemic corticosteroids, intravenous immunoglobulin, cyclosporine, mortality
Abstract
Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life-threatening condition with an estimated mortality of 5-10%. Multiple therapeutic regimens are routinely used, but literature comparing their effectiveness and safety remains limited.
Objective: To evaluate the effectiveness of commonly used treatments for DRESS, focusing on mortality, duration of treatment, and adverse effects.
Methods: We conducted a PubMed literature review for articles published between 2005 and 2022, including peer-reviewed publications with at least two DRESS patients treated with supportive care, systemic corticosteroids (SCS), intravenous immunoglobulin (IVIG), and/or cyclosporine. We excluded articles that did not clearly delineate the number of patients that received each treatment type and/or respective outcomes. We extracted and analyzed data including patient demographics, implicated drugs, treatment regimens, and outcomes.
Results: We included 19 studies encompassing 427 patients, dividing patient data into four groups by the treatment received: supportive care (92), SCS alone (276), SCS with IVIG (44), or cyclosporine (15). The mortality was 5.4% for supportive care, 8.0% for SCS, 13.6% for SCS with IVIG, and 0% for cyclosporine. Overall mortality was 7.7%. Adverse effects were most often attributed to SCS, including opportunistic infections and DRESS recurrence.
Conclusion: Supportive care may be appropriate for mild DRESS cases. While SCS are commonly used, their effectiveness and safety remain a concern. IVIG, though typically used in severe cases, revealed higher mortality. Cyclosporine had favorable outcomes and could be a more suitable DRESS treatment. Prospective, randomized trials are needed to further evaluate treatment efficacy and guide clinical decision-making.
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