儿童药物反应伴嗜酸性粒细胞增多和全身性症状诊疗进展

Diagnosis and therapeutic advances of drug reaction with eosinophilia and systemic symptoms

药物反应伴嗜酸性粒细胞增多和全身性症状(DRESS),即药物超敏反应综合征,是一种少见但严重的、具有潜在致命风险的、全身性的药物不良反应。任何年龄均可发病,儿童发病率及病死率低于成人。抗生素及抗惊厥药物是儿童DRESS常见的致敏药物。与成人相比,抗生素比例更高,潜伏期可小于2周。肝脏是最常见的受累器官。早期识别致敏药物并停用、早期诊断后立即治疗非常关键。系统应用糖皮质激素是中重度DRESS的一线治疗方法,生物制剂及小分子靶向药物应用前景广阔,但儿童应用的有效性及安全性仍需进一步研究支持。

Drug reaction with eosinophilia and systemic symptoms(DRESS),known as drug hypersensitivity syndrome,is a rare but serious,potentially fatal,and systemic adverse drug reaction.It may affect children,and the morbidity and mortality rates are lower in children than those in adults.Antibiotics and anticonvulsants are common culprit drugs for DRESS in children.Antibiotics may be more common in children compared with adults,and latency phase can be less than two weeks.Liver involvement is most common.Early identification and discontinuation of culprit drugs and immediate treatment after early diagnosis are critical.Systemic corticosteroid is the first-line treatment for moderate to severe DRESS.Targeted therapies are promising,but it need further evidence to use in children.