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Ramírez EAuthorSendagorta EAuthorGarcia-Samaniego JAuthorVega-Cabrera CAuthor

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Review

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome

Publicated to:JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY. 30 (4): 229-253 - 2020-01-01 30(4), DOI: 10.18176/jiaci.0480

Authors: Cabañas R, Ramírez E, Sendagorta E, Alamar R, Barranco R, Blanca-López N, Doña I, Fernández J, Garcia-Nunez I, García-Samaniego J, Lopez-Rico R, Marín-Serrano E, Mérida C, Moya M, Ortega-Rodríguez NR, Rivas Becerra B, Rojas-Perez-Ezquerra P, Sánchez-González MJ, Vega-Cabrera C, Vila-Albelda C, Bellón T

Affiliations

Alicante Univ Hosp, Allergy Sect, ISABIAL UMH, Alicante, Spain - Author
ARADyAL, Madrid, Spain - Author
Ctr Invest Red Enfermedades Raras CIBERER, U754, Madrid, Spain - Author
Hosp Clin San Cecilio, Allergy Unit, Granada, Spain - Author
Hosp Gen Univ Gregorio Maranon, Dept Allergy, Madrid, Spain - Author
Hosp Quironsalud Campo Gibraltar, Allergy & Pneumol Dept, Los Barrios, Cadiz, Spain - Author
Hosp Reg Univ Malaga, Allergy Unit, Malaga, Spain - Author
Hosp Univ & Politecn La Fe Valencia, Valencia, Spain - Author
Hosp Univ 12 Octubre, Allergy Unit, Madrid, Spain - Author
Hosp Univ A Coruna, Dept Allergy, La Coruna, Spain - Author
Hosp Univ Gran Canaria Dr Negrin, Allergy Unit, Las Palmas Gran Canaria, Spain - Author
Hosp Univ La Paz, Allergy Unit, Madrid, Spain - Author
Hosp Univ La Paz, Liver Unit, CIBERehd, IdiPAZ, Madrid, Spain - Author
Hosp Univ Torrecardenas, Allergy Unit, Almeria, Spain - Author
Infanta Leonor Univ Hosp, Allergy Serv, Madrid, Spain - Author
Inst Hlth Res IdiPAZ, Madrid, Spain - Author
Inst Invest Biomed Malaga IBIMA, Hosp Civil, Allergy Res Grp, Malaga, Spain - Author
La Paz Hosp, Drug Hypersensit Lab, Madrid, Spain - Author
La Paz Univ Hosp, Dept Nephrol, Madrid, Spain - Author
La Paz Univ Hosp, Dermatol Dept, Madrid, Spain - Author
La Paz Univ Hosp, Gastroenterol Dept, Madrid, Spain - Author
La Paz Univ Hosp, Pharmacol Dept, Madrid, Spain - Author
PIELenRed Consortium, Madrid, Spain - Author
Principe Asturias Univ Hosp, Dept Allergy, Alcala De Henares, Spain - Author
Severo Ochoa Univ Hosp, Allergy Unit, Madrid, Spain - Author
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Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome.Aim: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines.Methods: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts.Results: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Keywords

clinical-featurescorticosteroidscross-reactivitycutaneous adverse-reactionsdrug reaction with eosinophilia and systemic symptomsdrug-induced hypersensitivity syndromehuman-herpesvirus 6liver-injurylong-term sequelaelymphocyte transformation testlymphocyte-transformation testpatch testsscarskin testssystemic symptoms dresst-cellsCorticosteroidsDress syndromeDrug reaction with eosinophilia and systemic symptomsDrug-induced hypersensitivityDrug-induced hypersensitivity syndromeLymphocyte transformation testPatch testsScarSkin tests

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 13/28, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Allergy. Notably, the journal is positioned en el Cuartil Q3 para la agencia Scopus (SJR) en la categoría Immunology and Allergy.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.47. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 4.24 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 30.94 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-11, the following number of citations:

  • WoS: 42
  • Scopus: 101
  • Europe PMC: 28
  • OpenCitations: 80

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-11:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 199.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 199 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 3.7.
  • The number of mentions on the social network X (formerly Twitter): 6 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Gibraltar.