Introduction 

We all know that some people are susceptible to experiencing drug allergies(allergies to certain medicines). But did you know that some allergies can be potentially life-threatening? One such side effect is DRESS syndrome, which occurs when there is a drug-related rash with eosinophilia and systemic symptoms.

A rather rare condition, why does this DRESS syndrome occur and how can it be managed to prevent organ damage and haematological abnormalities?

Let us read on to find out.

Causes

When there is delayed T-cell mediated hypersensitivity response to drugs, it causes drug hypersensitivity syndrome or DRESS syndrome for short. The immune system becomes excessively active, the T cells become activated and cytokines are produced. This leads to cellular damage. 

. These are some of the medicines which may cause DRESS Syndrome:

• Some Antiviral medicines
• Medicines to treat seizures
• Allopurinol – a medicine used for gout
• Antibiotics like penicillin and cephalosporins
• Biologic agents
• Some Mood stabilisers and antidepressants
• NSAIDS like mefenamic acid, ibuprofen etc

You need not fear these medicines if you are not allergic to them and can take them as and when prescribed by your doctor. DRESS syndrome is a very rare allergic reaction that can happen to anyone. Awareness of DRESS Syndrome symptoms can help patients seek prompt medical care and prevent fatal complications. 

It is important to know that some other factors that can also play a role include the liver’s incapability to metabolise drugs, genetic susceptibility to DRESS syndrome and reactivation of viruses such as human herpesvirus and Epstein-Barr virus.

Symptoms

 A few of the most common symptoms of DRESS syndrome are:

Initial Symptoms-

• Eruption or skin rashes may be anywhere on the body but usually begin to appear on the face and upper body.
• Fever
• Swelling on face
• Weakness
• Swollen lymph nodes

On Progression of DRESS Syndrome, organs may get involved and may present with one or more of the symptoms listed below-

• Difficulty in eating and speaking due to inflammation of soft tissues lining the oral cavity and throat
• Jaundice in case of liver damage
• Decreased urine output in case of kidney damage
• Difficulty in breathing and cough when lungs are involved
• Involvement of the Heart is rare but can cause fatal outcomes. DRESS-induced myocarditis may present as difficulty in breathing, cough, low BP, high pulse rate and chest pain.
• GIT involvement may lead to vomiting, diarrhoea and bleeding
• Untreated DRESS may further affect other organs like the eyes, brain, gallbladder, spleen, thyroid, pancreas, etc.

It has been found that the symptoms of DRESS syndrome are likely to appear within 2-6 weeks of initiating the medicine.

How Doctors Diagnose DRESS Syndrome

DRESS syndrome is sometimes at risk of misdiagnosis because the symptoms are similar to other conditions, such as viral hepatitis, cellulitis and systemic lupus erythematosus. For the doctor to diagnose DRESS syndrome, the individual needs to meet 3 the following conditions (RegiSCAR criteria):

• Acute rash
• Hospitalisation
• Drug-related reaction
• Abnormality with blood count- increased eosinophils, abnormal lymphocyte count and decreased platelet count
• Involvement of one internal organ
• Enlarged lymph nodes 
• Fever greater than 38 degrees Celsius

Also Read: What is Marfan Syndrome: An Insight into Symptoms, Causes, and Treatment

Treatment

The easiest starting point for DRESS syndrome treatment is early recognition and halting of the responsible medication. This will solve blood abnormalities, tackle most of the symptoms and bring to a standstill the disease progression.

Following this, the nature of the treatment involves relieving and managing the symptoms. This involves:

• Controlling temperature
• Fluid replacement
• Nutrition
• Infection control
• Wound care
• Prescribing medication such as systemic corticosteroids and immunosuppressants as needed.

Patients need to be monitored for months after initial symptoms resolve to cut down any risks of organ damage.

Also Read: Castleman Disease: An Informative Guide To Its Symptoms And Treatments

Prevention

It is believed that people with DRESS syndrome may fully recover or some may experience a prolonged course. The only way to prevent a recurrence of DRESS syndrome is to refrain from taking the drug responsible for it. Maintain a record of medicines you are allergic to and always inform your doctors before they begin any new treatment. 

Conclusion

DRESS syndrome is a fatal immune system response to certain medicines It results in a medical emergency where there is a type 4 hypersensitivity reaction. DRESS syndrome, if not recognised and addressed timely, can lead to health complications in the long run, which can be life-threatening. Treatment involves stopping the drug responsible for stirring up the reactions supported by immunosuppressants to alleviate the symptoms. It is advised that you please consult a medical professional in the event of experiencing strange reactions following the start of any medicine.

Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.