Authors

Marie-Charlotte Brüggen, Sarah Walsh , M Milad Ameri, Natalie Anasiewicz, Emanual Maverakis, Lars E French, Saskia Ingen-Housz-Oro; DRESS Delphi consensus group; Richiiro Abe, Michael Ardern-Jones, Haudrey Assier, Annick Barbaud, Benoit Bensaid, William Bernal, Claire Bernier, Alain Brassard, Eva Brezinová, Rosario Cabañas, Adela Cardones, Chia-Yu Chu, Ser-Ling Chua, Vincent Descamps, Biagio Didona, Sherrie Jill Divito, Roni Dodiuk-Gad, Scott Elman, Krisztian Gaspar, Charlotte G Mortz, Natsumi Hama, Haur Yueh Lee, Barbara Horváth, Lukas Jörg, Benjamin H Kaffenberger, Vesta Kucinskiene, Bénédicte Lebrun-Vignes, Rannakoe J Lehloenya, Damian Meyersburg, Robert Micheletti, Brigitte Milpied, Fumi Miyagawa, Arash Mostaghimi, Mirjam Nägeli, Luigi Naldi, Eva Oppel, Elizabeth J Phillips, Tasneem Pirani, Annamari Ranki, Tarja Mälkönen, Misha Rosenbach, Carmen Salavastru, Delphine Staumont-Salle, Heidi Sandberg, Jane Setterfield, Kanade Shinkai, Tetsuo Shiohara, Angele Soria, Danielle Tartar, George-Sorin Tiplica, Stephan Traidl, Artem Vorobyev, Camilla von Wachter, Scott Worswick , Yung-Tsu Cho

Abstract

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.