Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms (2024)

• ¹Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland

• ²Faculty of Medicine, University of Zurich, Zurich, Switzerland

• ³Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland

• ⁴ToxiTEN group, European Reference Network for Rare Skin Diseases (ERN-Skin), Paris, France

• ⁵Department of Dermatology, King’s College Hospital, London, England, United Kingdom

• ⁶Department of Dermatology, University of California, Davis, Sacramento, California

• ⁷Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany

• ⁸Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida

• ⁹Department of Dermatology, Henri Mondor University Hospital, University of Paris-Est Créteil, Créteil, France

• ¹⁰Toxic Bullous Dermatoses TOXIBUL Reference Center, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France

• ¹¹Univ Paris Est Créteil EpiDermE, Créteil, France

Key Points

Question What is the optimal diagnostic and severity assessment as well as management of patients with drug reaction with eosinophilia and systemic symptoms (DRESS)?

Findings In this 2-round international Delphi exercise, a panel of 54 experts agreed on 93 statements regarding DRESS diagnosis and management. These statements included recommendations on diagnostic workup and multidisciplinary involvement, severity assessment, drug management, treatment, and follow-up care, as well as allergological workup.

Meaning DRESS is a complex, severe cutaneous adverse drug reaction that poses diagnostic and management challenges for clinicians; this consensus is aimed at providing needed support in diagnosis, assessment, and treatment of patients with DRESS.

Importance Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment.

Objective To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS.

Design, Setting, and Participants The Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022.

Main Outcomes/Measures The degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1.

Results In the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup.

Conclusions and Relevance This Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

Dermatology Cutaneous Drug Reactions Allergy and Clinical Immunology Clinical Pharmacy and Pharmacology Adverse Drug Events

Citation

Brüggen M, Walsh S, Ameri MM, et al. Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus. JAMA Dermatol. 2024;160(1):37–44. doi:10.1001/jamadermatol.2023.4450

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