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Chap. 16 - SEVERE, ACUTE ADVERSE CUTANEOUS DRUG REACTIONS II: DRESS SYNDROME AND SERUM SICKNESS-LIKE REACTION

Published online by Cambridge University Press:  07 September 2011

By
Ronni Wolf  and
Batya B. Davidovici
Edited by
Ronni Wolf ,
Batya B. Davidovici ,
Jennifer L. Parish  and
Lawrence Charles Parish
Ronni Wolf
Affiliation:
Hebrew University–Hadassah Medical School
Batya B. Davidovici
Affiliation:
Kaplan Medical Center
Ronni Wolf
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Batya B. Davidovici
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Jennifer L. Parish
Affiliation:
Jefferson Medical College of Thomas Jefferson University
Lawrence Charles Parish
Affiliation:
Jefferson Medical College of Thomas Jefferson University
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Summary

DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS

Background

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, formerly termed “drug hypersensitivity syndrome” (HSS), is a severe, potentially fatal adverse drug reaction characterized by skin rash, fever, lymph-node enlargement, and single- or multiple-organ involvement, characteristically occurring in a delayed fashion between 3 and 8 weeks after starting treatment with the culpable drug for the first time.

Phenytoin HSS was first described in 1939, 1 year after phenytoin had been introduced in the treatment of convulsive disorders. Similar reactions were reported during the following years, initially to various anticonvulsant drugs and later to many other drugs. Consequently, the name of this reaction was changed to the more widely inclusive HSS, instead of anticonvulsant-, sulfone-, or dapsone-hypersensitivity syndrome. The word “hypersensitivity” itself, however, is ambiguous and uninformative insofar as it may apply to any idiosyncratic reaction that fits one phase of the classic Gell and Coombs classification. Therefore, a more informative, precise, and clinically relevant term was proposed, “drug rash with eosinophilia and systemic symptoms” or DRESS. The suitability of the term DRESS has recently been questioned because eosinophilia need not necessarily be present in this syndrome, and a return to “drug-induced HSS” has been suggested.

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Emergency Dermatology , pp. 162 - 167
Publisher: Cambridge University Press
Print publication year: 2011

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