Key Evidence on DRESS from the Journal of Allergy and Clinical Immunology (2022)

Causative Drug Classes

Anti‑inflammatory agents are among the drug classes reported to trigger DRESS, adding to the well‑known culprits such as allopurinol, anticonvulsants, and antibiotics. 1

Persistent immunological dysregulation after drug withdrawal contributes to the prolonged and potentially relapsing course of DRESS. 1
Reactivation of herpesviruses (e.g., HHV‑6) is a contributing factor to disease progression and complications in DRESS. 1

All allergological testing (e.g., skin testing) should be postponed for at least 6 months after resolution of a DRESS episode to reduce the risk of inducing a systemic reaction and to allow immune recovery. 1
If the patient has received systemic corticosteroids (≥10 mg prednisone‑equivalent) or other immunosuppressants, testing should be delayed an additional 4 weeks after discontinuation of these agents. 1

Both delayed intradermal testing (dIDT) and patch testing (PT) are appropriate methods for identifying the culprit drug in DRESS. 1
dIDT demonstrates higher sensitivity than PT for detecting drug hypersensitivity in DRESS, especially for antibiotics and anticonvulsants. 1
Testing must employ the highest non‑irritating concentrations of the suspected drug to maximize diagnostic yield while avoiding false‑positive irritant reactions. 1
Positive delayed reactions are evaluated at 24–72 hours after test application, with extended readings up to 96 hours and 7 days for patch tests to capture late‑appearing responses. 1