Clinical Communications
Virus Reactivation in Drug Reaction with Eosinophilia and Systemic Symptoms (Dress) Results from a Strong Drug-Specific Immune Response

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Virus Reactivation is an Original Feature of Dress

Many investigators have reported that DRESS was accompanied by reactivation of one or several viruses of the herpes group, including human herpesvirus 6 (HHV6), HHV7, Epstein Barr virus (EBV), and human cytomegalovirus,1, 2 with a peak 2 to 3 weeks after initial symptoms.1 Virus reactivation has been reported in up to 60% of patients with DRESS,2 but it is neither invariable nor specific for DRESS, because viral activation has also been observed, even if less frequently, in other severe

Strong Drug-Specific Immune Response is Another Original Feature of Dress

In the current issue of JACI: In Practice, Hensel et al6 describe the immunopathologic features of a positive patch test to ceftriaxone in a case of DRESS, with a similar pattern to that of a prior biopsy of the rash, and suggesting a mixed type IVb and IVc hypersensitivity. Too few similar reports of patch test biopsies are available in DRESS, and more would be welcome.

If not definitely conclusive on immunological mechanisms of DRESS, the demonstration of positive patch tests to drugs is a

What is the Most Likely Primary Event in DRESS: Virus Activation or Drug Allergy?

There is no credible explanation of how virus reactivation, peaking 2 to 3 weeks after onset of DRESS,1 could induce a drug-specific immune response. Supporters of the viral theory of DRESS often refer both to the high frequency of eruptions due to aminopenicillins observed during EBV primary infection (infectious mononucleosis) and to the high rates of ADRs in persons living with human immunodeficiency virus (HIV). However, the incidence of amoxicillin-induced rash in pediatric patients with

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Cited by (18)

  • Does sensitization by SARS-CoV-2 immune complexes trigger DRESS syndrome?

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    The difficult differential diagnosis, especially with infectious diseases, increases mortality to 5–10% of the patients due to liver failure.14–17 Over 60% of the DRESS syndrome cases are associated with viral infection, especially human herpesvirus 6 and 7, Epstein Barr virus, and human cytomegalovirus.18 Numerous drugs from different categories have been involved in the DRESS syndrome, and its incidence seems to have been aggravated during the current pandemic.

  • Successful treatment of corticosteroid-dependent drug reaction with eosinophilia and systemic symptoms with cyclosporine

    2021, Annals of Allergy, Asthma and Immunology
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    Some of the most common medications that causes DRESS include aromatic anticonvulsant, sulfonamides, and allopurinol.2 DRESS is also associated with viral infections or reactivation of herpes viruses, such as human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus, and cytomegalovirus.3,4 Clinically, it presents with extensive morbilliform skin rash, fever, lymphadenopathy, hematological abnormalities (hypereosinophilia, atypical lymphocytes), and multiorgan involvement, including renal, hepatic, pulmonary, cardiac, and endocrine abnormalities.5,6

  • The Journal of Allergy and Clinical Immunology: In Practice 2017 Year in Review

    2018, Journal of Allergy and Clinical Immunology: In Practice
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    The other case series found HLA B62 in 3 of 6 cases of DRESS due to piperacillin/tazobactam, suggesting that it may be a risk factor for this condition.106 An editorial by Roujeau and Dupin254 discussed the role of virus reactivation in DRESS. Finally regarding SCARS, Trubiano et al255 reported a case of teicoplanin-induced TEN confirmed by in vitro tests (see below).

  • Intravenous Immunoglobulin May Be Beneficial as an Add-on Therapy in DRESS

    2018, Journal of Allergy and Clinical Immunology: In Practice
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No funding was received for this work.

Conflicts of interest: J.-C. Roujeau is on a Pfizer safety board; has received consultancy fees from Ab Science, Novartis, Clinicgen, and Menarini; and has provided expert testimony for McNeil consumers. N. Dupin declares no relevant conflicts of interest.

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