Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand
Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but life-threatening adverse drug reaction. Several criteria have been established to aid the diagnosis. However, patients with DRESS remained underdiagnosis and undertreatment. Methods: Medical records of hospitaliz...
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| Format: | Article |
| Language: | English |
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Elsevier
2016-10-01
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| Series: | Allergology International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1323893016300338 |
| _version_ | 1819293020581789696 |
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| author | Akarin Hiransuthikul Thanapoom Rattananupong Jettanong Klaewsongkram Pawinee Rerknimitr Marisa Pongprutthipan Kiat Ruxrungtham |
| author_facet | Akarin Hiransuthikul Thanapoom Rattananupong Jettanong Klaewsongkram Pawinee Rerknimitr Marisa Pongprutthipan Kiat Ruxrungtham |
| author_sort | Akarin Hiransuthikul |
| collection | DOAJ |
| description | Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but life-threatening adverse drug reaction. Several criteria have been established to aid the diagnosis. However, patients with DRESS remained underdiagnosis and undertreatment.
Methods: Medical records of hospitalized patients at the King Chulalongkorn Memorial Hospital from January 2004–December 2014 due to DRESS were enrolled retrospectively using RegiSCAR diagnostic criteria.
Results: A total of 52 patients were included. Thirty-seven patients (71.2%) were female. The four most common causative agents were phenytoin (23.1%), nevirapine (17.3%), allopurinol (15.4%), and cotrimoxazole (13.5%). The overall prevalence was 9.63 cases per 100,000 inpatients. Median onset time (IQR) was 16 (9–27) days. Allopurinol was associated with longer onset time than others (p = 0.014). Clinical presentation: skin rash 100%, fever 78.8%, and lymphadenopathy 50%. The majority (84.6%) had single internal organ involvement. The most common internal organ involvement was liver (94.2%). Allopurinol was associated with higher incidence of renal involvement (p = 0.01). Up to 60% of patients had eosinophilia. Allopurinol was associated with higher eosinophilia (p = 0.003). A half of patients received systemic corticosteroids. Two mortality cases were reported (omeprazole-fulminant hepatitis and phenytoin-nosocomial infection).
Conclusions: DRESS is associated with severe morbidity and mortality. Phenytoin, nevirapine, allopurinol, and cotrimoxazole were the major causes. Allopurinol-induced DRESS had the longest onset time, and was associated with higher eosinophilia and incidence of renal involvement. Raising awareness among both health care providers and public for early detection and withdrawal of the causative agent is critical to save life and reduce morbidity. |
| first_indexed | 2024-12-24T04:03:47Z |
| format | Article |
| id | doaj.art-1f3a8dd91d1a48df91b0373afc205be7 |
| institution | Directory Open Access Journal |
| issn | 1323-8930 |
| language | English |
| last_indexed | 2024-12-24T04:03:47Z |
| publishDate | 2016-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Allergology International |
| spelling | doaj.art-1f3a8dd91d1a48df91b0373afc205be72022-12-21T17:16:14ZengElsevierAllergology International1323-89302016-10-0165443243810.1016/j.alit.2016.04.001Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in ThailandAkarin Hiransuthikul0Thanapoom Rattananupong1Jettanong Klaewsongkram2Pawinee Rerknimitr3Marisa Pongprutthipan4Kiat Ruxrungtham5Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandDepartment of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandDivision of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, ThailandDivision of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandBackground: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but life-threatening adverse drug reaction. Several criteria have been established to aid the diagnosis. However, patients with DRESS remained underdiagnosis and undertreatment. Methods: Medical records of hospitalized patients at the King Chulalongkorn Memorial Hospital from January 2004–December 2014 due to DRESS were enrolled retrospectively using RegiSCAR diagnostic criteria. Results: A total of 52 patients were included. Thirty-seven patients (71.2%) were female. The four most common causative agents were phenytoin (23.1%), nevirapine (17.3%), allopurinol (15.4%), and cotrimoxazole (13.5%). The overall prevalence was 9.63 cases per 100,000 inpatients. Median onset time (IQR) was 16 (9–27) days. Allopurinol was associated with longer onset time than others (p = 0.014). Clinical presentation: skin rash 100%, fever 78.8%, and lymphadenopathy 50%. The majority (84.6%) had single internal organ involvement. The most common internal organ involvement was liver (94.2%). Allopurinol was associated with higher incidence of renal involvement (p = 0.01). Up to 60% of patients had eosinophilia. Allopurinol was associated with higher eosinophilia (p = 0.003). A half of patients received systemic corticosteroids. Two mortality cases were reported (omeprazole-fulminant hepatitis and phenytoin-nosocomial infection). Conclusions: DRESS is associated with severe morbidity and mortality. Phenytoin, nevirapine, allopurinol, and cotrimoxazole were the major causes. Allopurinol-induced DRESS had the longest onset time, and was associated with higher eosinophilia and incidence of renal involvement. Raising awareness among both health care providers and public for early detection and withdrawal of the causative agent is critical to save life and reduce morbidity.http://www.sciencedirect.com/science/article/pii/S1323893016300338Adverse drug reactionDrug hypersensitivityDrug-induced hypersensitivity syndromeEosinophilHHV-6 |
| spellingShingle | Akarin Hiransuthikul Thanapoom Rattananupong Jettanong Klaewsongkram Pawinee Rerknimitr Marisa Pongprutthipan Kiat Ruxrungtham Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand Allergology International Adverse drug reaction Drug hypersensitivity Drug-induced hypersensitivity syndrome Eosinophil HHV-6 |
| title | Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand |
| title_full | Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand |
| title_fullStr | Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand |
| title_full_unstemmed | Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand |
| title_short | Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand |
| title_sort | drug induced hypersensitivity syndrome drug reaction with eosinophilia and systemic symptoms dihs dress 11 years retrospective study in thailand |
| topic | Adverse drug reaction Drug hypersensitivity Drug-induced hypersensitivity syndrome Eosinophil HHV-6 |
| url | http://www.sciencedirect.com/science/article/pii/S1323893016300338 |
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