Overview
DIHS, also known as DRESS, is characterized by a conglomeration of symptoms and signs which include fever, extensive or generalised itchy red rashes and internal organ dysfunction.
Causes
Drugs which can cause DIHS include some of the anticonvulsant medications and sulphur antibiotics.
There may be enlargement of lymph nodes, elevated white blood cell count, raised blood eosinophils. Internal organs which can be affected include the liver, kidneys, thyroid gland, heart and lungs. Viral re-activation has been associated with DIHS. In most cases, DIHS occurs 2 to 6 weeks after initiation of the drug.
Prevention
What is a drug provocation test?
A drug provocation test is the controlled administration of a drug to diagnose an immune-mediated and non–immune-mediated drug reaction. It is usually done under medical supervision. Drug provocation test has the potential risk of inducing a more severe and uncontrollable relapse of the original reaction. It is therefore a test which should be reserved for specific situations and when the benefits outweigh the risks.
Detection & Treatment
Evaluating drug allergies/ cutaneous adverse drug reactions can be challenging. An accurate, detailed history and clinical examination will help to establish the type of CADR and to identify the culprit drug. Blood tests, skin biopsies and skin tests (eg. Skin prick tests, intradermal tests and patch tests) are sometimes needed in the evaluation, but the usefulness of these tests is dependent on the type of the reaction and the drugs involved.
Not all cases of drug allergies/ cutaneous adverse drug reactions require specific drug allergy testing and not every medication or type of CADR has a blood test or skin test to help in the diagnosis.
The mainstay of treatment of DIHS is systemic corticosteroids. Cautious taper of systemic corticosteroids is often needed as abrupt cessation has been associated with flare of the condition.
Care Management
After a drug allergy or hypersensitivity has been diagnosed, what should you do?
It is important to remember the drug(s) which you are allergic to and always inform your doctors about it. A wallet-size card stating the name of the drug and the reaction you had would be most useful in case of emergency. Avoidance of drugs which are you are allergic to will prevent unnecessary morbidity or mortality.
Drug allergies are captured on the electronic medical records that link many hospitals and clinics.
Specialties & Services
