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The phenomenon of drug rash, eosinophilia, systemic symptoms (DRESS) described in the case report by De Greef and colleagues1 is most likely the result of cellular apoptosis due to excessive cytokines and mediators released by drug-specific T-cells.2 Raised levels of interleukin-4 (IL-4), IL-5 and IL-13 have been reported in patients, and because these cytokines are responsible for maturation and differentiation of eosinophils, they explain the eosinophilia seen in this condition.2 Mediators released due to eosinophil degranulation, such as eosinophil-derived neurotoxin and major basic protein, activate and degranulate mast cells; subsequent histamine release can perpetuate the reaction. DRESS is known to cause serious end-organ damage, which raises the question of whether specific cytokine-directed therapy is likely to be beneficial in these patients. Only a well-designed clinical trial can answer this question.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/5/481#316124