DRESS, una reacción alérgica no mediada por IgE

Abstract

DRESS (drug reaction syndrome with eosinophilia and sys¬temic symptoms) is a rare drug-induced multisystemic hy-persensitivity response that can induce a severe cutaneous adverse reaction that is difficult to diagnose and treat. It fre-quently manifests as an extensive skin rash, systemic symp¬toms, lymphadenopathy, visceral organ involvement, and hematological alterations, mainly leukocytosis, eosinophilia, and sometimes atypical lymphocytosis that manifest 2 to 8 weeks after continuous administration of the responsible drug. The most prevalent drugs related with this syndrome are phenytoin, carbamazepine, allopurinol, and abacavir. Some specific human leukocyte antigen (HLA) alleles have been identified that are associated with hypersensitivity to these drugs. The pathophysiology of DRESS syndrome is not yet fully understood; the main hypothesis is a T-cell me¬diated hypersensitivity response when interacting with the major histocompatibility complex receptor in individuals with genetic susceptibility factors. The criteria of the European Registry of Severe Cutaneous Adverse Reactions to Drugs (RegiSCAR) are the most commonly used for the diagnosis of DRESS syndrome. Drug-induced hypersensitivity syndrome (DiHS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP) should be considered for any rash that appears following the administration of any drug. Therapy of this condition includes the elimination of the causative agent as soon as possible, as well as systemic corticosteroids which remain the mainstay of treatment of DRESS with in-ternal organ involvement. Steroid-sparing agents such as cyclosporine, intravenous immunoglobulins (IVIGs), and other immunosuppressive agents have been used successfully to contribute to treatment. Keywords: DRESS; drug hypersensitivity syndrome; adverse drug reactions; hypersensitivity reaction; eosinophilia.