Vol. 70 No. 2 (2023): April-June
−ABOUT THE COVER−
Any drug can cause side effects, which are sometimes classified as adverse drug reactions, categorized into type A and type B reactions. Type A reactions are common, predictable, dose-dependent, and related to the drug's mechanism of action, whereas type B reactions have entirely opposite characteristics. Within this context is drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome—a condition characterized by fever, multiorgan involvement, lymphocyte activation (adenopathy and atypical lymphocytosis), eosinophilia, skin rash, and possible association with viral reactivation. DRESS typically presents with a delayed onset (~21 days) after drug intake.
The prevalence of DRESS depends on the drug involved, with anticonvulsants, xanthine oxidase inhibitors, and antivirals being the most commonly implicated. However, these are not the only medications that can induce DRESS. Unfortunately, there is limited evidence (mostly case reports) beyond these drug groups to expand knowledge about this syndrome's association with other drugs. Genetic susceptibility factors have been linked to DRESS onset, including human leukocyte antigen (HLA) polymorphisms—for instance, HLA-B*15:02 is associated with carbamazepine-induced DRESS.
The pathophysiology of DRESS remains incompletely defined, but three hypotheses have been proposed: (1) the hapten/prohapten model, (2) the pharmacological interaction with immune receptors model, and (3) the altered peptide repertoire model. Since DRESS involves multiorgan damage, it is considered a serious condition requiring timely diagnosis and treatment, with a mortality rate of up to 10%, often due to delayed identification.
No specific biomarker is available for diagnosing DRESS; instead, the RegiSCAR scoring system is used, with a score greater than five required to confirm a definitive diagnosis. Treatment involves discontinuation of the suspected causative drug, followed by the initiation of systemic corticosteroids, which help counteract both clinical and laboratory manifestations. Identifying the causative drug is essential; however, patch testing, although frequently reported in case studies, remains controversial due to varying sensitivity depending on the drug involved, the drug concentration, the lack of standardization of concentrations and vehicles, and the stability of the drug preparation.
Multidisciplinary and multicenter collaboration is necessary to strengthen the understanding of all aspects of this syndrome.
Since the earliest human civilizations, medications have played a role in healing. From the prehistoric, Bronze, and Iron Ages to the earliest civilizations of the Sumerians, Akkadians, Babylonians, Egyptians, Chinese, and Indians, rudimentary pharmaceutical processes were already in use. After the Greco-Roman era, plant-based products such as basil for heart ailments, aloe for parasites, belladonna for insomnia and pain, and colchicine for rheumatism were employed. Over time, the development of alkaloids like morphine, antibiotics, vaccines, anesthetics, aspirin, and corticosteroids marked major medical advancements. In modern times, the development of new drugs has significantly improved human life expectancy and quality of life. However, these advancements have also introduced undesirable adverse drug reactions, leading to increased morbidity, mortality, hospitalizations, and healthcare costs.
Over time, understanding the pathophysiological mechanisms of these reactions has facilitated advancements in diagnostic methods, including skin prick, intradermal, and patch tests, as well as innovative in vitro tests such as specific IgE assays, basophil activation tests, and lymphocyte transformation tests. Controlled drug provocation tests in hospital settings have also become more frequent. Today, treatment no longer solely relies on drug avoidance. In cases of non-severe adverse reactions, oral or intravenous desensitization has proven to be highly effective and safe for most drugs—a promising development, particularly with the advent of new treatments like cancer immunotherapy and monoclonal antibodies.
Brief description of the cover: Drs. Gandhi F. Pavón Romero and Luis Manuel Terán (authors of the article Drug-Induced DRESS Syndrome from Antitubercular Drugs) and Dr. María del Rocío Hernández Morales (author of Adverse Drug Events in Hospitalized Patients: Prevalence, Causes, and Risk Factors).
Special acknowledgment for the creation and design of the cover: DG. Diana Gabriela Salazar
