Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review
Despite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and children who may be also burdened by delayed sequelae. It is an adverse drug reaction characterized by widespread skin involvement, fever,...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1108345/full |
| _version_ | 1827891157685764096 |
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| author | Elisa Manieri Arianna Dondi Iria Neri Marcello Lanari |
| author_facet | Elisa Manieri Arianna Dondi Iria Neri Marcello Lanari |
| author_sort | Elisa Manieri |
| collection | DOAJ |
| description | Despite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and children who may be also burdened by delayed sequelae. It is an adverse drug reaction characterized by widespread skin involvement, fever, lymphadenopathy, visceral involvement, and laboratory abnormalities (eosinophilia, mononucleosis-like atypical lymphocytes). It is more frequently triggered by anticonvulsants, sulphonamides, or antibiotics, the latter being responsible for up to 30% of pediatric cases. The disease typically develops 2–8 weeks after exposure to the culprit medication, with fever and widespread skin eruption; mild viral prodromes are possible. Unfortunately, diagnosis is challenging due to the absence of a reliable test; however, a score by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) allows to classify suspect patients into no, possible, probable, or definite DRESS cases. Moreover, rapid-onset DRESS syndrome has been described in recent years. It affects children more often than adults and differs from the most common form because it appears ≤15 days vs. >15 days after starting the drug, it is usually triggered by antibiotics or iodinated contrast media rather than by anticonvulsants and has a higher presence of lymphadenopathy. Differential diagnosis between rapid-onset antibiotic-driven DRESS syndrome, viral exanthems, or other drug eruptions may be challenging, but it is mandatory to define it as early as possible to start adequate treatment and monitor possible complications. The present review reports the latest evidence about the diagnosis and treatment of pediatric DRESS syndrome. |
| first_indexed | 2024-03-12T21:20:51Z |
| format | Article |
| id | doaj.art-6015c4d3aca14106a3b184b3caa89e8c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-12T21:20:51Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-6015c4d3aca14106a3b184b3caa89e8c2023-07-28T19:17:26ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-07-011010.3389/fmed.2023.11083451108345Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative reviewElisa Manieri0Arianna Dondi1Iria Neri2Marcello Lanari3Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, ItalyPediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDivision of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyPediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDespite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and children who may be also burdened by delayed sequelae. It is an adverse drug reaction characterized by widespread skin involvement, fever, lymphadenopathy, visceral involvement, and laboratory abnormalities (eosinophilia, mononucleosis-like atypical lymphocytes). It is more frequently triggered by anticonvulsants, sulphonamides, or antibiotics, the latter being responsible for up to 30% of pediatric cases. The disease typically develops 2–8 weeks after exposure to the culprit medication, with fever and widespread skin eruption; mild viral prodromes are possible. Unfortunately, diagnosis is challenging due to the absence of a reliable test; however, a score by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) allows to classify suspect patients into no, possible, probable, or definite DRESS cases. Moreover, rapid-onset DRESS syndrome has been described in recent years. It affects children more often than adults and differs from the most common form because it appears ≤15 days vs. >15 days after starting the drug, it is usually triggered by antibiotics or iodinated contrast media rather than by anticonvulsants and has a higher presence of lymphadenopathy. Differential diagnosis between rapid-onset antibiotic-driven DRESS syndrome, viral exanthems, or other drug eruptions may be challenging, but it is mandatory to define it as early as possible to start adequate treatment and monitor possible complications. The present review reports the latest evidence about the diagnosis and treatment of pediatric DRESS syndrome.https://www.frontiersin.org/articles/10.3389/fmed.2023.1108345/fullchildrendrug reaction with eosinophilia and systemic symptomsDRESSdrug reactiondrug hypersensitivityantibiotics |
| spellingShingle | Elisa Manieri Arianna Dondi Iria Neri Marcello Lanari Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review Frontiers in Medicine children drug reaction with eosinophilia and systemic symptoms DRESS drug reaction drug hypersensitivity antibiotics |
| title | Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review |
| title_full | Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review |
| title_fullStr | Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review |
| title_full_unstemmed | Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review |
| title_short | Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review |
| title_sort | drug rash with eosinophilia and systemic symptoms dress syndrome in childhood a narrative review |
| topic | children drug reaction with eosinophilia and systemic symptoms DRESS drug reaction drug hypersensitivity antibiotics |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1108345/full |
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