1. DRESS Syndrome
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2.  Define the Adverse Drug Reactions.
 Understand the Etiology of Adverse Drug
Reaction.
 Define DRESS Syndrome.
 Mention the Etiologic Causes.
 Recognize the pathophysiological mechanism
 Describe the Signs & Symptoms.
 Demonstrate the Diagnostic Investigations.
 Mention the Treatment options & preventive
methods.
 Describe the prognosis
OBJECTIVES

3.  Adverse drug reaction (ADR) is a broad
term referring to
unwanted, uncomfortable, or dangerous
effects that a drug may have.
 Side effect is an imprecise term often
used to refer to a drug's unintended
effects that occur within the therapeutic
range.
 All drugs have the potential for ADRs.
The Adverse Drug Reaction

4.  Type A reactions are pharmacological
effects that are predictable and dose-
dependent and consist of side effects and
drug interactions.
 Type B reactions are hypersensitivity
reactions that are unpredictable and not
dose-dependent, usually occurring at
normally tolerated doses.
Etiology of ADR

5.  Drug hypersensitivity (or DRESS)
is an immune-mediated reaction to
a drug.
 Also called drug-induced
hypersensitivity syndrome (DHS).
DRESS Syndrome

6. Defect in the way the
liver metabolizes drugs
Co-infection with the
human herpes virus 6
(HHV6)
Genetic predisposition to
drug hypersensitivity
syndrome
Etiology

7. Anti-gout drug
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Allopurinol The most common
drugs to cause this
reaction
Anti-epilepsy drugs (esp.
carbamazepine, phenobarbital and
phenytoin)
sulphonamide group of antibiotics.
Causative Drugs

8. 1. Introduction 2. Protein and large 3. Most drugs
of drugs polypeptide drugs act as haptens
Carrier
Pathophysiology

9. 3. Most drugs 4. Bind to
2. Protein and large
polypeptide drugs
peptides in
act as haptens (MHC) molecules
Carrier
α1
β
Carrier
α3
Pathophysiology α2

10. 4. Bind to 5. Immunogenic
peptides in protein stimulate
(MHC) molecules one or both of
Antidrug
Some drugs directly antibody
stimulate production
T-cell
α1
β responses
Carrier
α3
α2
A. cytokine
Pathophysiology
B.
Cytotoxicity

11. 6. Recognition to A. Releasing
drug protein on Inflammation
the MHC I or II cytokines
CD4
CD8 Tissue injury
Normal cellular tissue
MHC I Neutrophil enzymes, ROS
Drug carrier Neutrophil
Cytokines Macrophage

12. 6. Recognition to B.
drug protein on
ONLY MHC I Cytotoxicity
Cell lysis & tissue injury
MHC I
Drug carrier
CD8+ CTLs

13.  Symptoms and signs vary from mild to
severe depending on the patient and
drug
 Start up to 12 weeks after initiation of
drug treatment and can occur after a dose
increase.
 Symptoms may persist or recur for
several weeks after stopping drug
treatment.
Signs and Symptoms

14. Prominent
Hepatitis Exanthema
eosinophilia
Facial swelling Generalized edema Lymphadenopathy
Signs and Symptoms

15. Patient's report of a reaction soon after taking a drug
Effects of a drug, and results of a
Time of onset
repeat drug challenge
Sometimes drug provocation testing
Drug is given in escalating doses to
Is usually safe and effective
precipitate the reaction
Sometimes direct and indirect antiglobulin assays
For hematologic drug reactions
Diagnosis

16. Drug discontinuation
•stopping the implicated drug
• most symptoms & signs clear in a few days
Supportive treatment
•antihistamines
•corticosteroids
•epinephrine
Sometimes desensitization
•if sensitivity established
•if treatment is essential and no alternative
•reduces sensitivity only temporarily
Treatment

17. Avoiding the
drug
Carry
identification
or an alert
bracelet.
Prevention Charts
should be
marked.

18.  Hypersensitivity decreases with
time.
 The mortality from drug
hypersensitivity syndrome is
estimated at around 8%.
Prognosis

19.  The Merck Manual 9th E.
 Abbas & Lichtman, Basic
Immunology 3E.
 http://www.dermnetnz.org/reaction
s/drug-hypersensitivity-
syndrome.html
References

20. { THANKS