DRESS: Drug Reaction With Eosinophilia and Systemic Symptoms Essay

DRESS: Drug Reaction With Eosinophilia and Systemic Symptoms Essay

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DRESS, also known as Drug Reaction with Eosinophilia and Systemic Symptoms, is caused by exposure to certain medications. Those medications include phenobarbital, phenytoin, carbamazepine, minocycline, sulfonamides, dapsone and allopurinol. Current pathogenesis theories point to lymphocyte activation versus. active metabolites of drug compounds (possibly aromatic anti-seizure drugs). Symptoms usually begin several weeks after exposure to the offending agent. While no gold standard for diagnosis exists, RegiSCAR inclusion criteria requires hospitalization, reaction suspected to be drug-related, and 3 out of 4 signs: acute rash, Fever > 38 C, lymphadenopathy in 2 sites, involvement of at least one internal organ and blood count abnormalities (such as lymphocytosis and eosinophilia). The most common internal organ of involvement is the liver and the most common hematologic abnormality is atypical lymphocytosis or eosinophilia. Current treatment standards involve stopping the offending agent, supportive care and the use of systemic steroids.
According to Tas and Simonart, “systemic corticosteroids are known to inhibit the effect of IL-5 on eosinophil accumulation.” And it is eosinophil accumulation that is possibly the main reason for internal organ involvement seen in DRESS, thus advocating for use of systemic steroids in its management. Their studies of case reports also have shown relapses of DRESS after the withdrawal of systemic steroids. This evidence provides more support for the use of systemic corticosteroids in the treatment of DRESS. However, a potential risk factor of using systemic corticosteroids is viral reactivation (HHV-6) and steroid dependency. Viral reactivation may be important because one theory suggests that l...

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... children. Kocaoglu et al. stated the first choice in treatment of DRESS is to discontinue the offending agent. After that, the treatment regimen described by them is to use parenteral pulse corticosteroid treatment, as it was shown to have a more rapidly favorable clinical course as well as a return of liver function tests to normal in a shorter period of time.
In conclusion, there were several studies that showed the benefit in using systemic steroids, especially pulsed IV in the treatment of DRESS. However, caution must be exercised in interpreting these results since there are no large clinical studies to support this data. Also, much of the confusion from reviewing previous literature is that other studies may have misdiagnosed other conditions as DRESS, which is important because the use of steroids in management in these patients will cause further damage.

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