Experts determine best management for drug reaction with eosinophilia, systemic symptoms

Key takeaways:

• Mild to moderate disease should be treated with topical, high potency steroids.
• Severe disease should be treated with systemic glucocorticoids.

Experts weighed in on the best ways to treat mild to severe drug reaction with eosinophilia and systemic symptoms, according to a study.

“Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening drug hypersensitivity reaction,” Marie-Charlotte Brüggen, MD, PhD, of the department of dermatology at University Hospital of Zurich in Switzerland, and colleagues wrote. “There remain areas of major challenge in the management of patients with DRESS.”

To determine the best management techniques for DRESS, the authors consulted 54 experts in an international Delphi exercise.

According to the experts, DRESS can manifest as mild, moderate or severe. If mild, they recommend that physicians use topical, high potency steroids that should be tapered over 6 weeks to 3 months. The same applies to those with moderate DRESS, with the possible addition of systemic glucocorticoids.

If severe, the experts recommend initiating systemic glucocorticoids in all patients, tapering treatment over 6 weeks to 3 months.

If the patient has corticosteroid-refractory DRESS, physicians should consider cyclosporine, antibodies interfering with the interleukin (IL)-5 axis or intravenous immunoglobulins. If the patient has DRESS with high serum CMV viral load, physicians should consider antiviral treatment such as ganciclovir or valganciclovir.

In the first month after discharge, physicians should initiate regular follow-up consultations. Regular consultations should also take place during the following 6 months with a frequency in line with the patient’s needs.

During follow-ups, physicians should monitor patients’ organ functions and conduct blood tests, frequently screening for autoantibodies and thyroid dysfunction in the convalescence phase. For patients receiving prolonged systemic steroids, physicians should screen for adverse events. For all patients, psychological support should be offered.

“This Delphi exercise provides, to our knowledge, the first international expert consensus on the diagnostic workup, severity assessment and treatment of DRESS, aimed at helping clinicians optimally manage patients with DRESS,” the authors wrote. “The Delphi exercise also highlights gaps in knowledge that need to be addressed with additional collaborative studies to consolidate and expand the current consensus, but also address areas of uncertainty.”