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Editorial Review |

The Drug Hypersensitivity Syndrome:  What Is the Pathogenesis?

John R. Sullivan, MB, BS, FACD; Neil H. Shear, MD, FRCPC
Arch Dermatol. 2001;137(3):357-364. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-137-3-der00006.
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Drug hypersensitivity syndrome (DHS) is a severe idiosyncratic reaction associated with drug therapy. Cutaneous eruptions are the most common idiosyncratic reaction to drugs, but DHS is not just a drug-related eruption. We defined DHS by the clinical triad of fever, rash, and internal organ involvement.1 The pathogenesis of this disease is not well defined; however, intriguing clinical and laboratory observations and associations provide insight into the mechanistic puzzle of this iatrogenic disease. The article in this issue by Descamps et al2 raises further questions as to this syndrome's association with viral infection. Understanding the pathomechanism of DHS is important for the prevention and improved management of these potentially life-threatening reactions.

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Figure 1.

The potential interplay of factors reported with drug hypersensitivity syndrome. Drug hypersensitivity reactions occur more commonly in women than in men in most studies.

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Figure 2.

The potential role of reactive drug metabolites. Chemically reactive drug products usually constitute only a minor proportion of a drug's metabolites but are probably responsible for many serious adverse effects, including hypersensitivity reactions.

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