Beyond the drug: autoimmune predisposition to DRESS syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, severe hypersensitivity reaction characterized by rash, hematologic abnormalities, and multiorgan involvement. Although DRESS is typically triggered by medications, interindividual variability suggests a role for host-related factors. This study investigated whether underlying autoimmune diseases increase susceptibility to DRESS.

A retrospective, propensity score-matched case-control analysis was conducted using a large multicenter database, comparing 1128 patients with DRESS to 1128 controls matched by age, sex, and race. Autoimmune comorbidities were identified through ICD-10 codes encompassing systemic and organ-specific conditions.

Several autoimmune diseases were significantly more prevalent in patients with DRESS, including hypothyroidism (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.24-1.96; P < 0.001), type 2 diabetes mellitus (OR 1.58; 95% CI 1.31-1.91; P < 0.001), rheumatoid arthritis (OR 2.17; 95% CI 1.36-3.46; P < 0.001), psoriasis (OR 2.28; 95% CI 1.28-4.06; P = 0.004), inflammatory bowel disease (OR 1.81; 95% CI 1.08-3.04; P = 0.02), and mixed connective tissue disease (OR 2.59; 95% CI 1.52-4.44; P < 0.001).

These findings highlight the importance of heightened vigilance when prescribing high-risk medications to patients with autoimmune diseases and underscore the need for prospective studies exploring genetic and immunologic mechanisms linking autoimmunity and drug hypersensitivity.