Drug Rash Eosinophilia and Systemic Symptoms (DRESS) Syndrome Identified in the Electronic Health Record Allergy Module

Publication date: Available online 31 August 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Anna R. Wolfson, Li Zhou, Yu Li, Neelam A. Phadke, Ohn A. Chow, Kimberly G. Blumenthal

Abstract

Background

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe hypersensitivity reaction that remains poorly characterized in the US.

Objective

We aimed to identify and describe DRESS syndrome cases in an integrated healthcare system using electronic health record (EHR) allergy module free text searches.

Methods

We identified DRESS syndrome cases with rash, absolute eosinophil count ≥500/L, organ involvement, and RegiSCAR (European Registry of Severe Cutaneous Adverse Reactions [SCAR]) to Drugs and Collection of Biological Samples) score ≥2 by reviewing patients from 1980-2016 whose EHR allergic reaction matched DRESS-related keywords. Liver injury required alanine aminotransferase ≥100U/L and renal injury required creatinine increase by ≥0.5mg/dL or 50%. Patient and DRESS characteristics were described, resource use was determined, and cost was estimated.

Results

Among 3,162,562 patients with 3,319,387 million allergy entries, 538 reactions matched keywords, and 69 were DRESS cases (prevalence 2.18 in 100,000). DRESS patients had liver (42%) or renal (42%) injury; 11 (16%) had both liver and renal injury. Primary drug culprits were antibiotics (74%) (vancomycin [39%], beta-lactams [23%], fluoroquinolones [4%], tetracyclines [4%], and sulfonamides [3%]) and anticonvulsants (20%). Of 65 (94%) hospitalized DRESS patients, 43 (66%) were hospitalized for DRESS syndrome management with median length of stay 9 days [IQR, 6-17 days] and cost approximately $17,101 per patient.

Conclusions

Using free text search of the EHR allergy module identified a large US DRESS syndrome cohort. DRESS prevalence was 2.18 per 100,000 patients. Both liver and kidney injury were frequent, and vancomycin was the most common drug culprit. DRESS cases were morbid and resource-intensive.