Beyond the drug: autoimmune predisposition to DRESS syndrome.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, severe hypersensitivity reaction characterized by rash, hematologic abnormalities, and multiorgan involvement. Although DRESS is typically triggered by medications, interindividual variability suggests a role for host-related factors. This study investigated whether underlying autoimmune diseases increase susceptibility to DRESS.
A retrospective, propensity score-matched case-control analysis was conducted using a large multicenter database, comparing 1128 patients with DRESS to 1128 controls matched by age, sex, and race. Autoimmune comorbidities were identified through ICD-10 codes encompassing systemic and organ-specific conditions.
Several autoimmune diseases were significantly more prevalent in patients with DRESS, including hypothyroidism (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.24-1.96; P < 0.001), type 2 diabetes mellitus (OR 1.58; 95% CI 1.31-1.91; P < 0.001), rheumatoid arthritis (OR 2.17; 95% CI 1.36-3.46; P < 0.001), psoriasis (OR 2.28; 95% CI 1.28-4.06; P = 0.004), inflammatory bowel disease (OR 1.81; 95% CI 1.08-3.04; P = 0.02), and mixed connective tissue disease (OR 2.59; 95% CI 1.52-4.44; P < 0.001).
These findings highlight the importance of heightened vigilance when prescribing high-risk medications to patients with autoimmune diseases and underscore the need for prospective studies exploring genetic and immunologic mechanisms linking autoimmunity and drug hypersensitivity.
A retrospective, propensity score-matched case-control analysis was conducted using a large multicenter database, comparing 1128 patients with DRESS to 1128 controls matched by age, sex, and race. Autoimmune comorbidities were identified through ICD-10 codes encompassing systemic and organ-specific conditions.
Several autoimmune diseases were significantly more prevalent in patients with DRESS, including hypothyroidism (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.24-1.96; P < 0.001), type 2 diabetes mellitus (OR 1.58; 95% CI 1.31-1.91; P < 0.001), rheumatoid arthritis (OR 2.17; 95% CI 1.36-3.46; P < 0.001), psoriasis (OR 2.28; 95% CI 1.28-4.06; P = 0.004), inflammatory bowel disease (OR 1.81; 95% CI 1.08-3.04; P = 0.02), and mixed connective tissue disease (OR 2.59; 95% CI 1.52-4.44; P < 0.001).
These findings highlight the importance of heightened vigilance when prescribing high-risk medications to patients with autoimmune diseases and underscore the need for prospective studies exploring genetic and immunologic mechanisms linking autoimmunity and drug hypersensitivity.
Authors
Verma Verma, Nguyen Nguyen, Alam Alam, Goldstein Goldstein, Cutts Cutts, Tarbox Tarbox
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