Thanks to the leadership of Vincent Descamps, Professor of Dermatology at the Bichat Claude Bernard Hospital, University Denis Diderot in Paris, France, a French panel of experts has proposed that DRESS patients be treated with antivirals and/or immunoglobulins. The “French Investigators for Skin Adverse Reaction to Drug” (FISARD) have proposed that physicians treat life-threatening cases of DRESS with IV immunoblobulins and/or antiviral therapy.
Furthermore, Descamps has proposed that dermatologists recognize the important role of virus (especially HHV-6) and immune response to virus in patients who present with a ‘picture’ of DRESS but without any evidence of a drug trigger (often observed in transplant patients and emergency room patients). He suggests calling this condition VRESS or “Virus Reactivation with Eosinophilia and Systemic Symptoms.”
A survey of intensive care records in France indicated that the DRESS patients admitted to emergency rooms are typically in a state of shock, and have a mortality rate of DRESS of 47% out of 21 patients studied. Hepatic failure occurs in over half of the cases. Since significant HHV-6 reactivation is frequent in these patients, one question that requires urgent study is the possibility that viral activity could be exacerbated by high dose steroid therapy, and ultimately contribute to the late flare and organ failure. HHV-6 reactivation can cause liver and kidney failure in transplant patients under high levels of immunosuppression, but no studies have been conducted to date on the viral load in affected organs in DRESS/VRESS.
“Antiviral therapy could represent an opportunity to improve outcome in serious cases of drug hypersensitivity” commented Descamps who is currently conducting a trial of antiviral therapy in DRESS (VRESS) patients.