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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses. Microorganisms 2023; 11:microorganisms11020346. [PMID: 36838310 PMCID: PMC9966117 DOI: 10.3390/microorganisms11020346] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a heterogeneous, multiorgan and potentially life-threatening drug-hypersensitivity reaction (DHR) that occurs several days or weeks after drug initiation or discontinuation. DHRs constitute an emerging issue for public health, due to population aging, growing multi-organ morbidity, and subsequent enhanced drug prescriptions. DRESS has more consistently been associated with anticonvulsants, allopurinol and antibiotics, such as sulphonamides and vancomycin, although new drugs are increasingly reported as culprit agents. Reactivation of latent infectious agents such as viruses (especially Herpesviridae) plays a key role in prompting and sustaining aberrant T-cell and eosinophil responses to drugs and pathogens, ultimately causing organ damage. However, the boundaries of the impact of viral agents in the pathophysiology of DRESS are still ill-defined. Along with growing awareness of the multifaceted aspects of immune perturbation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing SARS-CoV-2-related disease (COVID-19) pandemic, novel interest has been sparked towards DRESS and the potential interactions among antiviral and anti-drug inflammatory responses. In this review, we summarised the most recent evidence on pathophysiological mechanisms, diagnostic approaches, and clinical management of DRESS with the aim of increasing awareness on this syndrome and possibly suggesting clues for future research in this field.
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Navarro-Triviño F, Ruiz-Villaverde R. [Translated article] Carbamezepine-Induced Acquired Multifocal Keratoderma. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Queratodermia multifocal adquirida inducida por carbamazepina. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:652-653. [DOI: 10.1016/j.ad.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/04/2020] [Accepted: 02/14/2021] [Indexed: 11/21/2022] Open
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de Groot AC. Patch testing in Drug reaction with eosinophilia and systemic symptoms (DRESS): a literature review. Contact Dermatitis 2022; 86:443-479. [PMID: 35233782 DOI: 10.1111/cod.14090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. 105 drugs were identified that have together caused 536 positive patch tests in 437 patients suffering from DRESS. By far most reactions (n=145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions are anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%) and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin) and possibly iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS, but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is (far) higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anton C de Groot
- dermatologist np Schipslootweg 5, 8351, HV, Wapserveen, The Netherlands
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Hypersensitivity Reactions to Antiepileptic Drugs in Children: Epidemiologic, Pathogenetic, Clinical, and Diagnostic Aspects. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1879-1891.e1. [DOI: 10.1016/j.jaip.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/17/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023]
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Turbett SE, Tsiaras WG, McDermott S, Eng G. Case 26-2018: A 48-Year-Old Man with Fever, Chills, Myalgias, and Rash. N Engl J Med 2018; 379:775-785. [PMID: 30134139 DOI: 10.1056/nejmcpc1807494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah E Turbett
- From the Departments of Medicine (S.E.T.), Radiology (S.M.), and Pathology (G.E.), Massachusetts General Hospital, the Department of Dermatology, Brigham and Women's Hospital (W.G.T.), and the Departments of Medicine (S.E.T.), Dermatology (W.G.T.), Radiology (S.M.), and Pathology (G.E.), Harvard Medical School - all in Boston
| | - William G Tsiaras
- From the Departments of Medicine (S.E.T.), Radiology (S.M.), and Pathology (G.E.), Massachusetts General Hospital, the Department of Dermatology, Brigham and Women's Hospital (W.G.T.), and the Departments of Medicine (S.E.T.), Dermatology (W.G.T.), Radiology (S.M.), and Pathology (G.E.), Harvard Medical School - all in Boston
| | - Shaunagh McDermott
- From the Departments of Medicine (S.E.T.), Radiology (S.M.), and Pathology (G.E.), Massachusetts General Hospital, the Department of Dermatology, Brigham and Women's Hospital (W.G.T.), and the Departments of Medicine (S.E.T.), Dermatology (W.G.T.), Radiology (S.M.), and Pathology (G.E.), Harvard Medical School - all in Boston
| | - George Eng
- From the Departments of Medicine (S.E.T.), Radiology (S.M.), and Pathology (G.E.), Massachusetts General Hospital, the Department of Dermatology, Brigham and Women's Hospital (W.G.T.), and the Departments of Medicine (S.E.T.), Dermatology (W.G.T.), Radiology (S.M.), and Pathology (G.E.), Harvard Medical School - all in Boston
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Ksouda K, Affes H, Mahfoudh N, Chtourou L, Kammoun A, Charfi A, Chaabane H, Medhioub M, Sahnoun Z, Turki H, Tahri N, Hammami S, Zeghal K. HLA-A*31:01 and carbamazepine-induced DRESS syndrom in a sample of North African population. Seizure 2017; 53:42-46. [PMID: 29125944 DOI: 10.1016/j.seizure.2017.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Drug rash with eosinophilia and systemic symptoms (DRESS) is a serious adverse drug reaction. Carbamazepine is the most common causes of this syndrome. The HLA-A*31:01 allele has been shown to be strongly correlated with carbamazepine-induced DRESS syndrome in European, Japanese, Han Chinese and other asian population but not in African populations. So, our purpose is to study there is a correlation between HLA-A*31:01 and carbamazepine-induced DRESS syndrome in africain population? METHODS HLA class I (A and B) typing was performed on 7 subjects with carbamazepine-DRESS syndrome and 25 tolerants controls subjects. DNA typing HLA class I (A) alleles was checked by the polymerase chain reaction amplification Sequence Specific Oligonucleotide Probes (SSO) (reverse-SSO assay). High resolution HLA DNA Kit based on the Luminex technology (One Lambda®) was used according to the manufacturer's protocol. RESULTS The HLA-A*31:01 allele, which has a prevalence of 1% in Tunisian population, was significantly associated with DRESS syndrome. It was detected in 57.14% of cases (4/7) and only 4% of controls subjects (1/25). Thus, the carrier frequency of HLA-A*31:01 allele in the cases group was also significantly higher than in the controls group (57, 14% vs 4% P = 0,004). Odds ratio is estimated 32 (OR = 32 [2.6; 389.2]) CONCLUSION: Similarly to other ethnicities, the presence of the HLA-A*31:01 allele was associated with carbamazepine-DRESS syndrome in a sample of North African population. Future study must be conducted on a larger sample in order to confirm these results.
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Affiliation(s)
- Kamilia Ksouda
- Pharmacology Department, School of Medicine, Sfax, Tunisia.
| | - Hanen Affes
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Nedia Mahfoudh
- Immunology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Lassad Chtourou
- Gastroenterology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Arwa Kammoun
- Immunology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Aida Charfi
- Immunology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hend Chaabane
- Dermatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Molka Medhioub
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Zouhir Sahnoun
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Hamida Turki
- Dermatology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nabil Tahri
- Gastroenterology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Serria Hammami
- Pharmacology Department, School of Medicine, Sfax, Tunisia
| | - Khaled Zeghal
- Pharmacology Department, School of Medicine, Sfax, Tunisia
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Bommersbach TJ, Lapid MI, Leung JG, Cunningham JL, Rummans TA, Kung S. Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review. Mayo Clin Proc 2016; 91:787-801. [PMID: 27126302 DOI: 10.1016/j.mayocp.2016.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/18/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.
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Affiliation(s)
- Tanner J Bommersbach
- Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Błaszczyk B, Lasoń W, Czuczwar SJ. Antiepileptic drugs and adverse skin reactions: An update. Pharmacol Rep 2015; 67:426-34. [DOI: 10.1016/j.pharep.2014.11.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 01/18/2023]
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Wang XQ, Xiong J, Xu WH, Yu SY, Huang XS, Zhang JT, Tian CL, Huang DH, Jia WQ, Lang SY. Risk of a lamotrigine-related skin rash: current meta-analysis and postmarketing cohort analysis. Seizure 2014; 25:52-61. [PMID: 25645637 DOI: 10.1016/j.seizure.2014.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/01/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We systematically reviewed studies to provide current evidence on the incidence and risk of skin rash in patients with LTG therapy. METHODS PubMed and Scopus databases, up to 15 March 2014 were searched to identify relevant studies. Eligible studies included prospective studies, retrospective studies and postmarketing reports, which included data of skin rash in patients with LTG therapy. RESULTS Forty-one articles met the entry criteria. A total of 4447 patients with LTG therapy from 26 prospective studies, 2977 patients from 8 retrospective studies, and 26,126 patients from 5/7 postmarketing reports were included. The overall incidence of skin rash with LTG therapy was 9.98% (444/4447) from prospective studies, 7.19% (214/2977) from retrospective studies, and 2.09% (547/26,126) from postmarketing reports. A meta-analysis of the risk of skin rash in 21 prospective studies, did not show a significant difference between patients with LTG and other drugs, including placebo, other ADEs or lithium (OR 0.99-2.41). In 6 respective studies, there was a significantly higher OR in patients with LTG compared with those with non-aromatic AEDs. However, there was no significant difference in rash risk between patients with LTG and aromatic AEDs. CONCLUSIONS Our study showed that LTG significantly increased the risk of developing a skin rash compared to non-aromatic AEDs. Our results support the need for large prospective population-based studies and clinical trials to determine whether LTG increases the risk of developing a skin rash than compared to other drugs.
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Affiliation(s)
- Xiang-qing Wang
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
| | - Jiang Xiong
- Department of Vascular Surgery, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Wen-Huan Xu
- Department of Scientific Research, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Sheng-yuan Yu
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Xu-sheng Huang
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Jia-tang Zhang
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Cheng-lin Tian
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - De-hui Huang
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Wei-quan Jia
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Sen-yang Lang
- Department of Neurology, The Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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Kaswala DH. Drug Rash with Eosinophilia and Systemic Symptoms Syndrome Due to Anti-TB Medication. J Family Med Prim Care 2014; 2:83-5. [PMID: 24479051 PMCID: PMC3894017 DOI: 10.4103/2249-4863.109958] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, idiosyncratic, multi-system reaction characterized by the clinical triad of fever, rash, and internal organ involvement. The mortality rate is estimated to be 8%, especially among patients with liver involvement, so early recognition is imperative. Drugs commonly associated with the development of DRESS syndrome include anticonvulsants, long-acting sulfonamides, and anti-inflammatory medications; however, there are no reported cases implicating anti-tuberculosis (anti-TB) medications. We report a case of DRESS syndrome from anti-TB therapy. A 68-year-old male with pulmonary TB presented with pruritic skin eruption and sore throat, 8 weeks after starting Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE) therapy. He takes metformin and glyburide for diabetes. Physical exam was significant for diffuse, exfoliative erythematous macules with target lesions involving the entire skin surface, without mucosal involvement. Laboratory data was significant for mild transaminitis and new onset eosinophilia. Given suspicion of drug eruption, RIPE therapy was discontinued. Skin biopsy confirmed erythema multiforme. Despite discontinuation of the implicated medications, eosinophilia and transaminitis continued to worsen, and so systemic corticosteroids were started. After 4 weeks of discontinuation of RIPE therapy, the cutaneous eruption resolved and laboratory data returned to normal. The patient is finishing course of anti-TB with cycloserine and moxifloxacin. Upon follow up as outpatient, the rash was resolving and disappeared in 1 month. DRESS syndrome is always considered when there is high eosinophil counts and multisystem involvement with skin eruptions. It can be potentially life threatening with certain drugs and infectious agents in predisposed individuals. It is imperative to discontinue the causative medication and avoid re-exposure.
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Affiliation(s)
- Dharmesh H Kaswala
- Department of Medicine, The University Hospital, New Jersey Medical School, UMDNJ, Newark, New Jersey, USA
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Barbaud A, Collet E, Milpied B, Assier H, Staumont D, Avenel-Audran M, Grange A, Amarger S, Girardin P, Guinnepain MT, Truchetet F, Lasek A, Waton J. A multicentre study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Br J Dermatol 2013; 168:555-62. [PMID: 23136927 DOI: 10.1111/bjd.12125] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Drug patch tests (PTs) can reproduce delayed hypersensitivity to drugs and entail a moderate re-exposure of patients to offending drugs. OBJECTIVES To determine the value of PTs for identifying the responsible drug in severe cutaneous adverse drug reactions (SCARs) such as acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). METHODS In a multicentre study, PTs were conducted on patients referred for DRESS, AGEP or SJS/TEN within 1 year of their SCAR. All drugs administered in the 2 months prior to and the week following the onset of the SCAR were tested. RESULTS Among the 134 patients included (48 male, 86 female; mean age 51·7 years), positive drug PTs were obtained for 24 different drugs. These included positive tests for 64% (46/72) of patients with DRESS, 58% (26/45) of those with AGEP and 24% (4/17) of those with SJS/TEN, with only one relapse of AGEP. The value of PTs depended on the type of drug and the type of SCAR (e.g. carbamazepine was positive in 11/13 DRESS cases but none of the five SJS/TEN cases). PTs were frequently positive for beta lactams (22 cases), pristinamycin (11 cases) and in DRESS with pump proton inhibitors (five cases), but were usually negative for allopurinol and salazopyrin. Of 18 patients with DRESS, eight had virus reactivation and positive PTs. In DRESS, multiple drug reactivity was frequent (18% of cases), with patients remaining sensitized many years later. CONCLUSIONS PTs are useful and safe for identifying agents inducing SCAR.
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Affiliation(s)
- A Barbaud
- Dermatology Department, University Hospital of Nancy, Pôle des Spécialités Médicales, Université de Lorraine, Brabois Hospital, 6 Rue du Morvan, Vandoeuvre-lès-Nancy 54500, France.
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Dreyfus DH. Herpesviruses and the microbiome. J Allergy Clin Immunol 2013; 132:1278-86. [PMID: 23611298 DOI: 10.1016/j.jaci.2013.02.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/07/2013] [Accepted: 02/25/2013] [Indexed: 12/15/2022]
Abstract
The focus of this article will be to examine the role of common herpesviruses as a component of the microbiome of atopic patients and to review clinical observations suggesting that atopic patients might be predisposed to more severe and atypical herpes-related illness because their immune response is biased toward a TH2 cytokine profile. Human populations are infected with 8 herpesviruses, including herpes simplex virus HSV1 and HSV2 (also termed HHV1 and HHV2), varicella zoster virus (VZV or HHV3), EBV (HHV4), cytomegalovirus (HHV5), HHV6, HHV7, and Kaposi sarcoma-associated herpesvirus (termed KSV or HHV8). Herpesviruses are highly adapted to lifelong infection of their human hosts and thus can be considered a component of the human "microbiome" in addition to their role in illness triggered by primary infection. HSV1 and HSV2 infection and reactivation can present with more severe cutaneous symptoms termed eczema herpeticum in the atopic population, similar to the more severe eczema vaccinatum, and drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is associated with reactivation of HSV6 and possibly other herpesviruses in both atopic and nonatopic patients. In this review evidence is reviewed that primary infection with herpesviruses may have an atypical presentation in the atopic patient and conversely that childhood infection might alter the atopic phenotype. Reactivation of latent herpesviruses can directly alter host cytokine profiles through viral expression of cytokine-like proteins, such as IL-10 (EBV) or IL-6 (cytomegalovirus and HHV8), viral encoded and secreted siRNA and microRNAs, and modulation of expression of host transcription pathways, such as nuclear factor κB. Physicians caring for allergic and atopic populations should be aware of common and uncommon presentations of herpes-related disease in atopic patients to provide accurate diagnosis and avoid unnecessary laboratory testing or incorrect diagnosis of other conditions, such as drug allergy or autoimmune disease. Antiviral therapy and vaccines should be administered promptly when indicated clinically.
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Affiliation(s)
- David H Dreyfus
- Department of Pediatrics, Clinical Faculty, Yale School of Medicine, New Haven, and the Center for Allergy, Asthma, and Immunology, Waterbury, Conn.
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Aouam K, Romdhane FB, Loussaief C, Salem R, Toumi A, Belhadjali H, Chaabane A, Boughattas NA, Chakroun M. Hypersensitivity Syndrome Induced by Anticonvulsants: Possible Cross-Reactivity Between Carbamazepine and Lamotrigine. J Clin Pharmacol 2013; 49:1488-91. [DOI: 10.1177/0091270009344985] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wang XQ, Lang SY, Shi XB, Tian HJ, Wang RF, Yang F. Antiepileptic drug-induced skin reactions: A retrospective study and analysis in 3793 Chinese patients with epilepsy. Clin Neurol Neurosurg 2012; 114:862-5. [DOI: 10.1016/j.clineuro.2012.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/30/2011] [Accepted: 01/15/2012] [Indexed: 10/14/2022]
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Abstract
The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as "no," "possible," "probable," or "definite" to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as "probable/definite" DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with "probable/definite" DRESS cases, whereas skin rash was described in almost all of the cases, including "possible cases." Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.
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Mathieu O, Picot MC, Gelisse P, Bretone H, Demoly P, Hillaire-Buys D. Effects of carbamazepine and metabolites on IL-2, IL-5, IL-6, IL-10 and IFN-γ secretion in epileptic patients: the influence of co-medication. Pharmacol Rep 2011; 63:86-94. [DOI: 10.1016/s1734-1140(11)70402-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 09/15/2010] [Indexed: 10/25/2022]
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Chaabane A, Aouam K, Fredj NB, Boughattas NA. DRESS syndrome : étude de 11 cas et revue de la littérature. Therapie 2010; 65:543-50. [DOI: 10.2515/therapie/2010072] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 08/31/2010] [Indexed: 11/20/2022]
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Fredj NB, Aouam K, Chaabane A, Toumi A, Rhomdhane FB, Boughattas N, Chakroun M. Hypersensitivity to amoxicillin after drug rash with eosinophilia and systemic symptoms (DRESS) to carbamazepine and allopurinol: a possible co-sensitization. Br J Clin Pharmacol 2010; 70:273-6. [PMID: 20653681 PMCID: PMC2911558 DOI: 10.1111/j.1365-2125.2010.03685.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 03/30/2010] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nadia Ben Fredj
- Service de Pharmacologie, Faculté de MédecineMonastir, Tunisia
| | - Karim Aouam
- Service de Pharmacologie, Faculté de MédecineMonastir, Tunisia
| | - Amel Chaabane
- Service de Pharmacologie, Faculté de MédecineMonastir, Tunisia
| | - Adnene Toumi
- Service de Maladies infectieuses, Hôpital Fattouma BourguibaMonastir, Tunisia
| | - Foued Ben Rhomdhane
- Service de Maladies infectieuses, Hôpital Fattouma BourguibaMonastir, Tunisia
| | | | - Mohamed Chakroun
- Service de Maladies infectieuses, Hôpital Fattouma BourguibaMonastir, Tunisia
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Aouam K, Nadia BF, Amel C, Naceur B. Amoxicillin-Induced Hypersensitivity After DRESS To Carbamazepine. World Allergy Organ J 2010; 3:220-2. [PMID: 23282653 PMCID: PMC3651104 DOI: 10.1097/wox.0b013e3181eab930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The anticonvulsant hypersensitivity syndrome, also known as drug rash eosinophilia and systemic symptoms (DRESS), is a rare but severe form of adverse cutaneous reaction. Several aromatic anticonvulsant drugs, such as carbamazepine (CBZ), phenytoin, or phenobarbital have been frequently associated with the onset of DRESS. Cross-reactivity among the aromatic anticonvulsants frequently occurs (40 to 80% of patients). However, cross reactivity with other drugs such as betalactams have exceptionally been reported. We report a clinical observation describing a DRESS associated with CBZ with a subsequent hypersensitivity to amoxicillin (AMX). A 34-year-old male with a 20-year history of epilepsy was treated with valproic acid and phenobarbital. As he had frequent convulsive fits, CBZ was added. Thirty-four days later, the patient developed hyperthermia (39.5°C), cervical lymphadenopathy, and generalized cutaneous exfoliated maculae and papulae. Biochemical investigation was characterized by a white cell count of (16.1 × 103/μL, 17% eosinophils) and increased levels of aspartate aminotransferase and alanine aminotransferase (50 and 116 IU/L, respectively). CBZ was discontinued. One month later, all the symptoms were progressively relieved. Six weeks after complete recovery, prick and patch skin tests were performed. They were strongly positive at 48-hour reading. About 2 years later, the patient exhibited an extensive pruritic skin rash, 2 days after AMX intake. Laboratory exams showed eosinophilia (7%) but neither elevated liver enzymes nor renal dysfunction. All these symptoms have disappeared 5 days after AMX withdrawal. Intradermal test to AMX was positive but not to other betalactams. Throughout this clinical observation, we report a CBZ-induced DRESS and describe the possibility of cross reactivity between CBZ and AMX. This cross reactivity was observed despite the lack of chemical similarity between both drugs.
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Affiliation(s)
- Karim Aouam
- Service de Pharmacologie, Faculté de Médecine, Monastir, Tunisia
| | - Ben Fredj Nadia
- Service de Pharmacologie, Faculté de Médecine, Monastir, Tunisia
| | - Chaabane Amel
- Service de Pharmacologie, Faculté de Médecine, Monastir, Tunisia
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22
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Barbaud A. [Drug patch tests in the investigation of cutaneous adverse drug reactions]. Ann Dermatol Venereol 2009; 136:635-44. [PMID: 19686903 DOI: 10.1016/j.annder.2009.06.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cutaneous adverse drug reactions (CADR) are a frequent problem in clinical medicine. Since patients are often on multiple drug regimes, it is often difficult to pinpoint the relevant drug from history alone. Besides clinical and chronological parameters, patch testing with the suspected compound has been reported as helpful in determining the cause of a CADR and in studying the physiopathological mechanisms involved in such reactions. The key advantage of drug patch tests is that they can be performed using any commercialized form of drugs and without hospital surveillance because they only rarely induce adverse reactions, which in any event are mild. The method for performing drug patch tests has been described, and requisite commercialized material is now commercially available, failing which the best approach is to dilute the drug in its commercialized form at 30% in petrolatum or in water. The results of drug patch tests depend on the drug tested and the clinical features of the initial CADR. They appear to be of value in investigating maculopapular rash, eczema at drug injection sites, photosensitivity (photopatch tests with 5J of irradiation), fixed drug eruption (testing at the sequelae site), acute generalized exanthematous pustulosis and symmetrical drug-related intertriginous flexural exanthema. Although less widely used, they are probably also of value in drug reaction with eosinophilia and systemic symptoms (DRESS) but they are of less use in Stevens-Johnson syndrome (SSJ) and Lyell's syndrome. Many drugs have been reported as producing positive patch tests, and most of these are summarized in a summary table of this literature review.
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Affiliation(s)
- A Barbaud
- Service de dermatologie, hôpital Fournier, CHU de Nancy, 36, quai de la Bataille, 54000 Nancy, France.
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