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Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially life‐threatening, delayed, drug‐induced hypersensitivity reaction. Immediate withdrawal of the culprit drug and administration of systemic corticosteroids is the most widely accepted treatment. However, it...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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John Wiley and Sons Inc.
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932711/ https://www.ncbi.nlm.nih.gov/pubmed/34796665 http://dx.doi.org/10.1111/cts.13201 |
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author | Sim, Da Woon Yu, Jieun Koh, Young‐Il |
author_facet | Sim, Da Woon Yu, Jieun Koh, Young‐Il |
author_sort | Sim, Da Woon |
collection | PubMed |
description | Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially life‐threatening, delayed, drug‐induced hypersensitivity reaction. Immediate withdrawal of the culprit drug and administration of systemic corticosteroids is the most widely accepted treatment. However, it is difficult to manage patients with DRESS syndrome who are not responsive to systemic steroids. We studied the efficacy of intravenous immunoglobulins (IVIGs) in patients with DRESS syndrome unresponsive to systemic steroids. We retrospectively reviewed patients with DRESS syndrome who received IVIG in addition to systemic steroids during 2012–2017 and compared the clinical features and course of DRESS syndrome, before and after IVIG treatment. Eighteen DRESS patients (9 men) were included. The most frequent offending drugs were dapsone in five patients, followed by vancomycin in three patients, and carbamazepine in three patients. Rash, fever, lymphadenopathy, atypical lymphocytes, and hepatic involvement were common clinical findings. IVIG treatment was added within a median time of 7 days from the commencement of systemic steroid therapy. After IVIG treatment (total dosage: 1–2 g/kg), the fever resolved within a median time of 1 day (range, 0–3) and liver enzymes improved substantially within a median time of 13 days (range, 0–27). No severe adverse reactions related to IVIG therapy were observed in this study; however, there was one case of mortality. The addition of IVIG in DRESS syndrome in cases refractory to systemic steroid treatment may be helpful in hastening recovery. However, comparative studies using a placebo group are needed. |
format | Online Article Text |
id | pubmed-8932711 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89327112022-03-24 Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome Sim, Da Woon Yu, Jieun Koh, Young‐Il Clin Transl Sci Research Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, potentially life‐threatening, delayed, drug‐induced hypersensitivity reaction. Immediate withdrawal of the culprit drug and administration of systemic corticosteroids is the most widely accepted treatment. However, it is difficult to manage patients with DRESS syndrome who are not responsive to systemic steroids. We studied the efficacy of intravenous immunoglobulins (IVIGs) in patients with DRESS syndrome unresponsive to systemic steroids. We retrospectively reviewed patients with DRESS syndrome who received IVIG in addition to systemic steroids during 2012–2017 and compared the clinical features and course of DRESS syndrome, before and after IVIG treatment. Eighteen DRESS patients (9 men) were included. The most frequent offending drugs were dapsone in five patients, followed by vancomycin in three patients, and carbamazepine in three patients. Rash, fever, lymphadenopathy, atypical lymphocytes, and hepatic involvement were common clinical findings. IVIG treatment was added within a median time of 7 days from the commencement of systemic steroid therapy. After IVIG treatment (total dosage: 1–2 g/kg), the fever resolved within a median time of 1 day (range, 0–3) and liver enzymes improved substantially within a median time of 13 days (range, 0–27). No severe adverse reactions related to IVIG therapy were observed in this study; however, there was one case of mortality. The addition of IVIG in DRESS syndrome in cases refractory to systemic steroid treatment may be helpful in hastening recovery. However, comparative studies using a placebo group are needed. John Wiley and Sons Inc. 2021-11-26 2022-03 /pmc/articles/PMC8932711/ /pubmed/34796665 http://dx.doi.org/10.1111/cts.13201 Text en © 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Research Sim, Da Woon Yu, Jieun Koh, Young‐Il Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome |
title | Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome |
title_full | Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome |
title_fullStr | Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome |
title_full_unstemmed | Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome |
title_short | Efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive DRESS syndrome |
title_sort | efficacy of add‐on therapy with intravenous immunoglobulin in steroid hyporesponsive dress syndrome |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932711/ https://www.ncbi.nlm.nih.gov/pubmed/34796665 http://dx.doi.org/10.1111/cts.13201 |
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