■伴嗜酸性粒细胞增多和全身症状的药物反应(DRESS)是一种罕见但可能致命的药物超敏反应。据我们所知,对其严重程度的评估和治疗没有国际共识。
■要达到国际,基于德尔菲的跨国专家关于诊断工作的共识,严重性评估,和DRESS患者的治疗。
■Delphi方法用于评估与基线检查相关的100个陈述,严重程度评估,急性期,和DRESS的急性后管理。邀请了57名DRESS国际专家,54人参加了调查,发生在2022年7月至9月。
■用RAND-UCLA适当性方法计算一致度。共识被定义为适当性值中值为7或更高(适当)且分歧指数低于1的陈述。
■在第一轮Delphi中,就82项声明达成共识。第二轮对13份声明进行了修订和评估。总共达成了93项声明的共识。专家们商定了一套基本的诊断检查程序以及针对严重性和器官的进一步调查。他们在严重程度评估(轻度,中度,并且严重)根据肝脏的程度,肾,血液受累和其他器官的损害。小组根据这些严重程度等级就DRESS管理的主线达成了一致。对DRESS患者的急性期随访和变态反应检查提出了一般建议。
■此Delphi练习代表,根据我们的知识,关于诊断工作的第一个国际专家共识,严重性评估,和服装管理。这应支持临床医生诊断和管理DRESS,并构成制定未来指南的基础。
UNASSIGNED: Drug reaction with
eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international
consensus on its severity assessment and treatment.
UNASSIGNED: To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS.
UNASSIGNED: The Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022.
UNASSIGNED: The degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1.
UNASSIGNED: In the first Delphi round,
consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A
consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup.
UNASSIGNED: This Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future
guidelines.