作者
Marie‐Charlotte Brüggen,Sarah Walsh,Milad Ameri,Natalie Anasiewicz,Emanual Maverakis,Lars E. French,S. Oro,Riichiro Abe,Michael R. Ardern‐Jones,Haudrey Assier,A. Barbaud,Benoît Bensaïd,William Bernal,C. Bernier,Alain Brassard,Eva Březinová,Rosario Cabañas,Adela R. Cardones,Chia‐Yu Chu,Ser-Ling Chua,V. Descamps,Biagio Didona,Sherrie J. Divito,Roni P. Dodiuk‐Gad,Scott A. Elman,Krisztián Gáspár,Charlotte G. Mørtz,Natsumi Hama,Haur Yueh Lee,Barbara Horváth,Lukas Jörg,Benjamin H. Kaffenberger,Vesta Kučinskienė,Bénédicte Lebrun‐Vignes,Rannakoe Lehloenya,Damian Meyersburg,Robert G. Micheletti,B. Milpied,Fumi Miyagawa,Arash Mostaghimi,Mirjam Nägeli,Debabrata Bandyopadhyay,Eva Oppel,Elizabeth Phillips,Tasneem Pirani,Annamari Ranki,Tarja Mälkönen,Misha Rosenbach,Carmen Sălăvăstru,D. Staumont‐Sallé,Heidi Sandberg,Jane Setterfield,Kanade Shinkai,Tetsuo Shiohara,Angèle Soria,Danielle Tartar,George‐Sorin Ţiplica,Stephan Traidl,Artem Vorobyev,Camilla von Wachter,Scott Worswick,Yung‐Tsu Cho
摘要
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment.To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS.The Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022.The degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1.In the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup.This Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.