DRESS SYNDROME

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Context: The Indian Pharmacopoeia Commission (IPC) has alerted about mefenamic acid (Meftal), a commonly used painkiller, due to potential Drug Reactions with Eosinophilia and Systemic Symptoms (DRESS) Syndrome based on Adverse Drug Reactions (ADRs) analysis from the PvPI database.

Details

• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a severe and potentially life-threatening hypersensitivity reaction that can occur as a response to various medications.

DRESS Syndrome

Onset and Symptoms

• Symptoms typically appear around 2 to 8 weeks after starting the medication.
• Symptoms include fever, rash (morbilliform rash - measles-like), facial swelling, and lymph node enlargement.
• Besides skin symptoms, organs like the liver, lungs, or kidneys can be affected, leading to more severe complications.

Causes

• DRESS Syndrome can be triggered by a wide array of drugs, although some medications are more commonly associated, including antiepileptic drugs, antibiotics, allopurinol (used for gout), and NSAIDs (like Mefenamic acid).
• Unlike immediate allergic reactions, symptoms of DRESS Syndrome appear after a few weeks of initiating the drug.

Diagnosis

• Diagnosis is based on clinical symptoms and a temporal association with starting a new medication.
• Eosinophilia (an increase in a type of white blood cells called eosinophils) and abnormal liver or kidney function tests might be observed.

Treatment of DRESS Syndrome

• The primary and crucial step in managing DRESS Syndrome is stopping the medication responsible for the reaction.
• Depending on the severity, organ involvement might require specialized care.
• Topical steroids for skin involvement and systemic steroids (oral or intravenous) might be needed in severe cases to dampen the immune response.
• Close monitoring of organ function and blood tests during and after treatment is essential.

Prognosis and Follow-up

• Recovery can take weeks to months. The average recovery time is about six to nine weeks.
• While most patients recover well, there's a possibility of developing autoimmune diseases later on. Thus, ongoing monitoring might be necessary.

Prevention and Precautions

• Since predicting who might develop DRESS Syndrome is challenging, it's advisable to use caution with medications and report any adverse reactions promptly to healthcare providers.
• Only take over-the-counter painkillers or any medication under the guidance of a healthcare professional, especially if there's a history of adverse drug reactions.

Conclusion

• DRESS Syndrome, while rare, emphasizes the importance of cautious medication usage and close monitoring of adverse drug reactions to ensure patient safety. Early recognition and prompt intervention play a crucial role in managing this condition.