Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology | 2021
Successful treatment of corticosteroid-dependent drug reaction with eosinophilia and systemic symptoms with cyclosporine.
Abstract
BACKGROUND\nDrug reaction with eosinophilia and systemic symptoms (DRESS) is an intractable drug hypersensitivity disease with high mortality. The current standard treatment requires high-dose and long-term systemic corticosteroids, which may lead to adverse effects and intolerability of patients.\n\n\nOBJECTIVE\nTo assess the efficacy and safety of cyclosporine in patients with corticosteroid-dependent DRESS or intolerance to systemic corticosteroids.\n\n\nMETHODS\nA retrospective review of eight patients with corticosteroid-dependent DRESS who were treated with cyclosporine as an alternative treatment due to suboptimal response to regular doses of systemic corticosteroids for at least three weeks, flare-ups when tapering corticosteroids, or experience intolerable side effects of corticosteroids.\n\n\nRESULTS\nIn all eight patients (4 women and 4 men; age range: 15-75 years), either intractable skin eruptions, persistent eosinophilia or elevated liver function were noted after at least three weeks of treatment with systemic corticosteroids. The patients demonstrated marked cutaneous improvement, normalization of liver function and eosinophil count after adding cyclosporine and the systemic corticosteroid treatment was smoothly tapered down. The mean dosage of cyclosporine was 1.68±0.73 mg/kg/day, and the mean duration of cyclosporine treatment was 76.13±35.64 days. Their serum eosinophil counts, serum ALT levels, and serum thymus and activation regulated chemokine (TARC) levels were all elevated at the baseline and then significantly decreased during the recovery stage after cyclosporine therapy (p <0.05). No adverse events were reported after adding cyclosporine.\n\n\nCONCLUSION\nCyclosporine is an effective and safe therapeutic alternative as a steroidsparing agent for corticosteroid-dependent DRESS. Further prospective randomized controlled studies are required to confirm these preliminary results.