Abstract: Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug reaction characterized by a skin rash, eosinophilia, and organ involvement.
Objective: Our purpose is to focus on the clinical and epidemiological characteristics of DRESS in the elderly and to identify the incriminated drugs.
Methods: This is a retrospective study including patients, hospitalized for DRESS with a RegiSCAR ≥4. The population was divided into 2 groups according to age: 65 years or older (G1) and <65 years (G2). The statistical study was performed using the comparative and multivariate analysis.
Results: We included 55 patients (30.9% G1 and 69.1% G2). Skin manifestations were comparable in both groups. Lymphadenopathy was less common in G1 with a statistically significant difference (P = 0.012). Renal impairment was more frequent in the elderly with a statistically significant result (P = 0.005). DRESS in the elderly group was significantly associated with the occurrence of sepsis (P = 0.008). Allopurinol was the most common culprit associated with DRESS in G1 (P = 0.001). Relapses and recurrences were comparable in both groups (P = 0.71).
Conclusions: DRESS in the elderly is associated with a high risk of complications, mainly kidney involvement and sepsis. Allopurinol is the most incriminated drug.
Get full access to this article
View all access options for this article.
References
1.
MizukawaY, HiraharaK, KanoY, et al.Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease. J Am Acad Dermatol. 2019; 80(3):670–678.e2.
2.
DeA, RajagopalanM, SardaA, et al.Drug reaction with eosinophilia and systemic symptoms: an update and review of recent literature. Indian J Dermatol. 2018; 63(1):30–40.
3.
CacoubP, MusetteP, DescampsV, et al.The DRESS syndrome: a literature review. Am J Med. 2011; 124(7):588–597.
4.
BégaudB, MartinK, FourrierA, et al.Does age increase the risk of adverse drug reactions?. Br J Clin Pharmacol. 2002; 54(5):550–552.
ShioharaT, MizukawaY. Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): an update in 2019. Allergol Int. 2019; 68(3):301–308.
7.
KardaunSH, SekulaP, Valeyrie-AllanoreL, et al.Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013; 169(5):1071–1080.
8.
ToniatoA, GambaC, SchroederJW, et al.Role of multiple comorbidities and therapies in conditioning the clinical severity of DRESS: a Mono-Center Retrospective Study of 25 Cases. Int J Mol Sci. 2021; 22(13):7072.
9.
SasidharanpillaiS, ChathothAT, KhaderA, et al.Predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Indian J Dermatol Venereol Leprol. 2019; 85(3):266–275.
10.
ChaabaneA, RomdhaneHB, FadhelNB, et al.DRESS characteristics according to the causative medication. Eur J Clin Pharmacol. 2022; 78(9):1503–1510.
11.
ChenYC, ChoYT, ChangCY, et al.Drug reaction with eosinophilia and systemic symptoms: a drug-induced hypersensitivity syndrome with variable clinical features. Dermatol Sin. 2013; 31(4):196–204.
12.
PeyrièreH, DereureO, BretonH, et al.Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist?. Br J Dermatol. 2006; 155(2):422–428.
13.
KanoY, IshidaT, HiraharaK, et al. Visceral involvements and long-term sequelae in drug-induced hypersensitivity syndrome. Med Clin North Am. 2010; 94(4):743–759, xi.
14.
ChoYT, YangCW, ChuCY. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): an interplay among drugs, viruses, and immune system. Int J Mol Sci. 2017; 18(6):1243.
15.
JevticD, DumicI, NordinT, et al.Less known gastrointestinal manifestations of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a systematic review of the literature. J Clin Med. 2021; 10(18):4287.
16.
TaweesedtPT, NordstromCW, StoeckelJ, et al.Pulmonary manifestations of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a systematic review. Biomed Res Int. 2019; 2019:e7863815.
17.
YoungJWS, ShearNH. Cutaneous drug reactions in the elderly. Drugs Aging. 2017; 34(9):655–672.
18.
WinderM, OwczarekAJ, MossakowskaM, et al.Prevalence of hyperuricemia and the use of allopurinol in older poles—results from a Population-Based PolSenior Study. Int J Environ Res Public Health. 2021; 18(2):387.
19.
ScavoneC, Di MauroC, RuggieroR, et al.Severe cutaneous adverse drug reactions associated with allopurinol: an analysis of Spontaneous Reporting System in Southern Italy. Drugs Real World Outcomes. 2019; 7(1):41–51.
20.
AtzoriL, PinnaAL, MantovaniL, et al.Cutaneous adverse drug reactions to allopurinol: 10 year observational survey of the Dermatology Department—Cagliari University (Italy). J Eur Acad Dermatol Venereol. 2012; 26(11):1424–1430.
21.
RamasamySN, Korb-WellsCS, KannangaraDRW, et al.Allopurinol hypersensitivity: a systematic review of all published cases, 1950–2012. Drug Saf. 2013; 36(10):953–980.
22.
KridinK, BrüggenMC, WalshS, et al.Management and treatment outcome of DRESS patients in Europe: an International Multicentre Retrospective Study of 141 cases. J Eur Acad Dermatol Venereol. Published online December 1, 2022. doi:10.1111/jdv.18808
