Drug-Induced Hypersensitivity Syndrome/Drug Reaction With Eosinophilia and Systemic Symptoms: Predictive Score and Outcomes

Yoshiko Mizukawa; Natsumi Hama; Fumi Miyagawa; Hayato Takahashi; Youichi Ogawa; Maiko Kurata; Hideo Asada; Riichiro Abe; Tetsuo Shiohara

doi:10.1016/j.jaip.2023.06.065

Drug-Induced Hypersensitivity Syndrome/Drug Reaction With Eosinophilia and Systemic Symptoms: Predictive Score and Outcomes

J Allergy Clin Immunol Pract. 2023 Oct;11(10):3169-3178.e7. doi: 10.1016/j.jaip.2023.06.065. Epub 2023 Jul 10.

Authors

Yoshiko Mizukawa¹, Natsumi Hama², Fumi Miyagawa³, Hayato Takahashi⁴, Youichi Ogawa⁵, Maiko Kurata⁶, Hideo Asada³, Riichiro Abe², Tetsuo Shiohara⁶

Affiliations

¹ Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. Electronic address: ymizu@ks.kyorin-u.ac.jp.
² Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
³ Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan.
⁴ Department of Dermatology, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
⁵ Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
⁶ Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.

PMID: 37437776
DOI: 10.1016/j.jaip.2023.06.065

Abstract

Background: We previously developed a drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) severity (DDS) score that may predict DIHS/DRESS-associated complications (DACs), including myocarditis, gastrointestinal bleeding, and autoimmune diseases.

Objective: To externally confirm the predictive accuracy of the DDS score, clarify its ability to identify patients at high risk of DACs and fatal outcome, and determine which treatments might reduce or increase the risk.

Methods: We conducted a nationwide multicenter retrospective study in which we followed 48 patients with DIHS/DRESS at 5 university hospitals in Japan for 1 year after onset. Patients were divided into mild, moderate, and severe DIHS/DRESS groups depending on their early DDS score.

Results: Eight cases had DACs in the severe group (n = 17); no DACs were observed in the mild group (n = 12). Receiver-operating characteristic curve analysis showed that a cutoff DDS score of ≥4.0 and ≤2.0 could differentiate patients who would and would not develop DACs, respectively. In the moderate-to-severe disease groups, DACs occurred only in patients who received corticosteroids and not in those who received supportive care. None of the patients who received early treatment for cytomegalovirus developed DACs. Autoimmune DACs were significantly more common in patients who received pulse corticosteroid therapy. Four deaths occurred within the 1-year follow-up; all were in patients with infectious DACs who received systemic corticosteroids.

Conclusion: Our scoring system allows early identification of patients at increased risk for DACs. Risk factors for DACs include systemic or pulse corticosteroid therapy.

Keywords: Autoimmune complications; Drug reaction with eosinophilia and systemic symptoms; Drug-induced hypersensitivity syndrome; Infectious complications; Predictive score.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Autoimmune Diseases* / drug therapy
Drug Hypersensitivity Syndrome* / drug therapy
Eosinophilia* / drug therapy
Humans
Retrospective Studies

Substances

Adrenal Cortex Hormones