These two authors contributed equally to the manuscript.
Clinical and Laboratory Investigations
Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study
Version of Record online: 31 OCT 2013
© 2013 British Association of Dermatologists
British Journal of Dermatology
Volume 169, Issue 5, pages 1071–1080, November 2013
How to Cite
Kardaun, S.H., Sekula, P., Valeyrie-Allanore, L., Liss, Y., Chu, C.Y., Creamer, D., Sidoroff, A., Naldi, L., Mockenhaupt, M., Roujeau, J.C. and the RegiSCAR study group (2013), Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. British Journal of Dermatology, 169: 1071–1080. doi: 10.1111/bjd.12501
Funding source The RegiSCAR study was funded by grants from the European Commission (QLRT-2002-01738), GIS-Institut des Maladies Rares and INSERM (4CH09G) in France, and by a consortium of Pharmaceutical companies (Bayer Vital, Boehringer-Ingelheim, GlaxoSmithKline, MSD Sharp and Dohme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Servier, Wyeth).
Conflict of interest JC Roujeau was or is a member of the advisory board on drug safety for following companies. Boehringer-Ingelheim, Janssen, OM-Pharma, Menarini, Pfizer, Servier, Vertex. He was a consultant for Cephalon, Johnson & Johnson, Janssen, Medimune, Roche and Sanofi-Aventis. Role of the sponsors: The sponsors had no role in the design or conduct of the study, in the collection, analysis, and interpretation of data, or in the preparation, review, or approval of the manuscript.
- Issue online: 31 OCT 2013
- Version of Record online: 31 OCT 2013
- Accepted manuscript online: 16 JUL 2013 03:04AM EST
- Manuscript Accepted: 2 JUL 2013
- European Commission. Grant Number: QLRT-2002-01738
- GIS-Institut des Maladies Rares and INSERM. Grant Number: 4CH09G
Cases of severe drug hypersensitivity, demonstrating a variable spectrum of cutaneous and systemic involvement, are reported under various names, especially drug reaction with eosinophilia and systemic symptoms (DRESS). Case definition and overlap with other severe cutaneous adverse reactions (SCAR) are debated.
To analyse the spectrum of signs and symptoms of DRESS and distribution of causative drugs in a large multicentre series.
Patients and methods
RegiSCAR, a multinational registry of SCAR, prospectively enrolled 201 potential cases from 2003 to mid-2009. Using a standardized scoring system, 117 cases were validated as showing probable or definite DRESS.
The male/female ratio was 0·80; females were borderline significantly younger than males. Next to the ubiquitous exanthema, the main features were eosinophilia (95%), visceral involvement (91%), high fever (90%), atypical lymphocytes (67%), mild mucosal involvement (56%) and lymphadenopathy (54%). The reaction was protracted in all but two patients; two patients died during the acute phase. Drug causality was plausible in 88% of cases. Antiepileptic drugs were involved in 35%, allopurinol in 18%, antimicrobial sulfonamides and dapsone in 12% and other antibiotics in 11%. The median time interval after drug intake was 22 days (interquartile range 17–31) for all drugs with (very) probable causality, with differences between drugs.
This prospective observational study supports the hypothesis that DRESS is an original phenotype among SCAR in terms of clinical and biological characteristics, causative drugs, and time relation. The diversity of causative drugs was rather limited, and mortality was lower than that suggested by prior publications.