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Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus.

Publication ,  Journal Article
Brüggen, M-C; Walsh, S; Ameri, MM; Anasiewicz, N; Maverakis, E; French, LE; Ingen-Housz-Oro, S; DRESS Delphi consensus group, ; Abe, R; Chu, C-Y ...
Published in: JAMA Dermatol
January 1, 2024

IMPORTANCE: 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. OBJECTIVE: To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES/MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.

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Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

January 1, 2024

Volume

160

Issue

1

Start / End Page

37 / 44

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Humans
  • Eosinophilia
  • Drug Hypersensitivity Syndrome
  • Delphi Technique
  • Consensus
  • Adult
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

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Chicago
ICMJE
MLA
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Brüggen, M.-C., Walsh, S., Ameri, M. M., Anasiewicz, N., Maverakis, E., French, L. E., … Cho, Y.-T. (2024). Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus. JAMA Dermatol, 160(1), 37–44. https://doi.org/10.1001/jamadermatol.2023.4450
Brüggen, Marie-Charlotte, Sarah Walsh, M Milad Ameri, Natalie Anasiewicz, Emanual Maverakis, Lars E. French, Saskia Ingen-Housz-Oro, et al. “Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus.JAMA Dermatol 160, no. 1 (January 1, 2024): 37–44. https://doi.org/10.1001/jamadermatol.2023.4450.
Brüggen M-C, Walsh S, Ameri MM, Anasiewicz N, Maverakis E, French LE, et al. Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus. JAMA Dermatol. 2024 Jan 1;160(1):37–44.
Brüggen, Marie-Charlotte, et al. “Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus.JAMA Dermatol, vol. 160, no. 1, Jan. 2024, pp. 37–44. Pubmed, doi:10.1001/jamadermatol.2023.4450.
Brüggen M-C, Walsh S, Ameri MM, Anasiewicz N, Maverakis E, French LE, Ingen-Housz-Oro S, DRESS Delphi consensus group, Abe R, Ardern-Jones M, Assier H, Barbaud A, Bensaid B, Bernal W, Bernier C, Brassard A, Brezinová E, Cabañas R, Cardones A, Chu C-Y, Chua S-L, Descamps V, Didona B, Divito SJ, Dodiuk-Gad R, Elman S, Gaspar K, Mortz CG, Hama N, Lee HY, Horváth B, Jörg L, Kaffenberger BH, Kucinskiene V, Lebrun-Vignes B, Lehloenya RJ, Meyersburg D, Micheletti R, Milpied B, Miyagawa F, Mostaghimi A, Nägeli M, Naldi L, Oppel E, Phillips EJ, Pirani T, Ranki A, Mälkönen T, Rosenbach M, Salavastru C, Staumont-Salle D, Sandberg H, Setterfield J, Shinkai K, Shiohara T, Soria A, Tartar D, Tiplica G-S, Traidl S, Vorobyev A, von Wachter C, Worswick S, Cho Y-T. Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus. JAMA Dermatol. 2024 Jan 1;160(1):37–44.

Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

January 1, 2024

Volume

160

Issue

1

Start / End Page

37 / 44

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Humans
  • Eosinophilia
  • Drug Hypersensitivity Syndrome
  • Delphi Technique
  • Consensus
  • Adult
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences