Dress syndrome

1. DRESS Syndrome Drug Reaction with Eosinophilia and Systemic Symptoms

2. Define the Adverse Drug Reactions. Understand the E tiology 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. The Adverse Drug Reaction 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.

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. Etiology

7. The most common drugs to cause this reaction Causative Drugs

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

9. Pathophysiology 2. Protein and large polypeptide drugs Carrier Carrier α 3 α 2 α 1 β 3. Most drugs act as haptens 4. Bind to peptides in (MHC) molecules

10. Pathophysiology Carrier α 3 α 2 α 1 β 4. Bind to peptides in (MHC) molecules 5. Immunogenic protein stimulate one or both of Some drugs directly stimulate Antidrug antibody production

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

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

13. Signs and Symptoms 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.

14. Signs and Symptoms

15. Diagnosis

16. Treatment

17. Prevention

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

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

20. THANKS FATIMA ALAWADH