When Common Medications Trigger a Rare Reaction: A Review of Clinical Features, Diagnosis, and Treatment Options of DRESS Syndrome

HAJDUK, Aleksandra, MROZEK, Łukasz, KLOCEK, Konrad, KOSTECKI, Bartosz, JUREK, Aleksander, ZWOLSKI, Maciej, SZUMLAS, Zuzanna & PUCHALSKI, Krzysztof. When Common Medications Trigger a Rare Reaction: A Review of Clinical Features, Diagnosis, and Treatment Options of DRESS Syndrome. Journal of Education, Health and Sport. 2023;29(1):11-21. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2023.29.01.001 https://apcz.umk.pl/JEHS/article/view/43623 https://zenodo.org/record/7927094 The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 21, 2021. No. 32343. Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences). Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 21 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159. Przypisane dyscypliny naukowe: Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu). © The Authors 2023; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 18.04.2023. Revised: 20.04.2023. Accepted: 15.05.2023. Published: 15.05.2023. When Common Medications Trigger a Rare Reaction: A Review of Clinical Features, Diagnosis, and Treatment Options of DRESS Syndrome Aleksandra Hajduk 1, Łukasz Mrozek 2, Konrad Klocek 3, Bartosz Kostecki 4 , Aleksander Jurek 5, Maciej Zwolski 6, Zuzanna Szumlas 7, Krzysztof Puchalski 8 1 Warszawski Uniwersytet Medyczny, Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0005-4648-376X 2 Samodzielny Publiczny Specjalistyczny Szpital Zachodni im. Św. Jana Pawła II, ul. Daleka 11, 05-825 Grodzisk Mazowiecki, Poland https://orcid.org/0009-0009-3262-8576 3 Górnośląskie Centrum Medyczne im. prof. Leszka Gieca Śląskiego Uniwersytetu Medycznego w Katowicach, Ziołowa 45-47, 40-635 Katowice, Poland https://orcid.org/0000-0002-3628-4223 4 SP ZOZ Szpital Wielospecjalistyczny w Jaworznie, Józefa Chełmońskiego 28, 43-600 Jaworzno, Poland https://orcid.org/0009-0002-6305-1764 5 UCK WUM Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005 Warszawa, Poland https://orcid.org/0009-0000-4858-5595 6 Szpital św. Elżbieta w Katowicach ul. Warszawska 52, 40-008 Katowice, Poland https://orcid.org/0000-0001-7255-4668 7 LUX MED Sp. z o.o., ul. Postępu 21C, 02-676 Warszawa, Poland https://orcid.org/0009-0007-4154-2796 8 Samodzielny Publiczny Zespół Zakładów Opieki Zdrowotnej im. Marszałka Józefa Piłsudskiego w Płońsku, 09-100 Płońsk, ul. Henryka Sienkiewicza 7, Poland https://orcid.org/0009-0005-2366-4971 ABSTRACT Introduction and purpose: Drug-induced reaction with eosinophilia and systemic symptoms (DRESS) is a severe, life-threatening systemic drug reaction. The challenges in identifying DRESS syndrome result from its symptoms being variable, diverse, and unspecific. Due to the potentially lethal consequence, any clinician should be aware of the symptomatology and be prepared to initiate the appropriate steps. This review summarizes the clinical manifestations and provides essential information on the management of the illness. State of knowledge: DRESS appears to be a rare reaction that frequently remains undetected due to its atypical clinical presentation. Fever, skin rash, lymphadenopathy, eosinophilia, and organ involvement as well as other manifestations, may occur. The onset may be delayed by weeks after exposure to the offending drug. DRESS syndrome is classified as a type IV hypersensitivity. It is thought to be triggered by antiepileptic drugs and antibiotics although many other medications can cause the condition. Certain genetic factors may also predispose some individuals to develop DRESS. Combining clinical and laboratory findings can help confirm the diagnosis. Discontinuation of the offending drug is the fundamental component of treatment such as supportive care including the use of antihistamines and corticosteroids, but recent research has discovered additional promising therapy options. Conclusions: Detecting DRESS syndrome early is crucial to ensure prompt treatment, prevent serious complications, and improve patient outcomes. Healthcare providers should be aware of the signs and symptoms of DRESS syndrome, especially in patients taking particular medications, and be prepared to investigate further if it is suspected. Keywords DRESS, drug reaction, eosinophilia, cutaneous reaction, hypersensitivit