Diagnosing and Managing Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Amidst Remaining Uncertainty

Drug reaction with eosinophilia and systemic symptoms (DRESS), a severe cutaneous adverse reaction, represents a diagnostic and therapeutic challenge due to its varied, evolving clinical presentation, complex pathophysiology, and potential for severe systemic involvement. This article explores DRESS syndrome through 3 illustrative cases from diverse populations and with different background comorbidities. Cases highlight different challenges in DRESS care, including (1) the need for early diagnosis and severity scoring, (2) identification of offending drugs and risk stratification to consider a possible drug challenge, and (3) best practice management including long-term monitoring for emergent autoimmunity. Recent developments in our understanding of clinical spectrum of disease, genomic and nongenomic biomarkers, severity groupings, and pharmacological and longer-term management strategies are described. Critical gaps remain in several of these domains, particularly in vulnerable groups such as the immune-compromised. In the absence of robust evidence, we aim in this article to assist attending clinicians with current expert opinion in DRESS management. Finally, we highlight areas for further research needed to improve the clinical care and outcomes of DRESS.