Published: 1 June 2017

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DRESS: A Pleat for Help

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Prescriber Update 38(2): 20-21
June 2017

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening drug-induced hypersensitivity reaction with an estimated mortality of 10%¹. It is characterised by rash, fever, haematologic abnormalities (eosinophilia, atypical lymphocytosis), lymphadenopathy and internal organ involvement (liver, kidneys, lungs) ^1-3.

Healthcare professionals are reminded there are many medicines that have been associated with DRESS (Table 1). Antiepileptic medicines (eg, carbamazepine, lamotrigine, phenytoin) and allopurinol are the medicines most frequently associated with DRESS in the scientific literature⁴. Sulphonamides, minocycline and vancomycin may also cause DRESS ⁵.

Table 1: Examples of medicines associated with DRESS⁵

Frequently reported	Allopurinol, carbamazepine, lamotrigine, phenytoin, sulfasalazine, vancomycin, minocycline, dapsone, sulfamethoxazole
Also reported	Beta-lactam antibiotics, nevirapine, olanzapine, oxcarbazepine, strontium ranelate, telaprevir

Most recently, in May 2016, the United States Food and Drug Administration (FDA) warned that olanzapine may cause DRESS ⁶. Medsafe is working to ensure that the New Zealand data sheets for all olanzapine-containing products include information on DRESS.

The Centre for Adverse Reactions Monitoring (CARM) has received 39 case reports that included a diagnosis of DRESS from 1 January 2012 to 31 December 2016. The most commonly reported suspected medicines were allopurinol (13 cases), vancomycin (4), piperacillin/tazobactam and sulfasalazine (3 each).

Further information on DRESS is available in a previous edition of Prescriber Update (www.medsafe.govt.nz/profs/PUArticles/DRESSsyndromeJune2011.htm).

References

1. Husain Z, Reddy BY, Schwartz RA. 2013. DRESS syndrome: Part I. Clinical perspectives. Journal of the American Academy of Dermatology 68: 693 e1-14; quiz 706-8.
2. Bocquet H, Bagot M, Roujeau JC. 1996. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Seminars in Cutaneous Medicine and Surgery 15: 250-7.
3. Husain Z, Reddy BY, Schwartz RA. 2013. DRESS syndrome: Part II. Management and therapeutics. Journal of the American Academy of Dermatology 68: 709 e1-9; quiz 18-20.
4. Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. 2013. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. British Journal of Dermatology 169: 1071–80.
5. Roujeau JC. 2017. Drug reaction with eosinophilia and systemic symptoms (DRESS). Waltham, MA: UpToDate. URL: uptodate.com/contents/drug-reaction-with-eosinophilia-and-systemic-symptoms-dress (accessed 20 April 2017).
6. US FDA. 2016. FDA warns about rare but serious skin reactions with mental health drug olanzapine. Drug Safety Communication 10 May 2016. URL: fda.gov/downloads/Drugs/DrugSafety/UCM499603.pdf (accessed 20 April 2017).