{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T07:34:28Z","timestamp":1793432068429,"version":"4.5.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Allergy Asthma Clin Immunol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but serious delayed hypersensitivity reaction that can be caused by antibiotic exposure. The reaction typically develops in 2 to 6 weeks. The pathophysiology is thought to involve toxic drug metabolites acting as a hapten, triggering a systemic response. The diagnosis is made clinically but can be confirmed using assays such as the lymphocyte toxicity assay (LTA), which correlates cell death upon exposure to drug metabolites with susceptibility to hypersensitivity reactions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentations<\/jats:title>\n                <jats:p>Case 1 involves a previously healthy 11-month-old male with first exposure to amoxicillin-clavulanate, prescribed for seven days to treat a respiratory infection. The patient developed DRESS fourteen days after starting the drug and was successfully treated with corticosteroids. LTA testing confirmed patient susceptibility to hypersensitivity reactions with amoxicillin-clavulanate. Parental samples were also tested, showing both maternal and paternal susceptibility. Neither parent reported prior hypersensitivity reactions. Lifelong penicillin avoidance for the patient was advised along with the notation in medical records of penicillin allergy. The parents were advised to avoid penicillin class antibiotics and be monitored closely for DRESS if they are exposed.<\/jats:p>\n                <jats:p>Case 2 involves an 11-year-old female with atopic dermatitis with first exposure to amoxicillin-clavulanate, prescribed for ten days to treat a secondary bacterial skin infection. She developed DRESS eleven days after starting antibiotics and was successfully treated with corticosteroids. LTA testing confirmed patient susceptibility to hypersensitivity reactions with amoxicillin-clavulanate. Maternal samples were also tested and showed sensitivity. The mother reported no prior hypersensitivity reactions. Lifelong penicillin avoidance for the patient was advised along with the notation in medical records of penicillin allergy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Amoxicillin-clavulanate is a commonly used antibiotic and the cases we have described suggest that it should be recognized as a potential cause of DRESS in pediatric patients. Furthermore, these cases contribute to current literature supporting that there may be a shorter latent period in DRESS induced by antibiotics. We have also shown that the LTA can be a helpful tool to confirm DRESS reactions, and that testing may have potential implications for family members.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13223-021-00535-4","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T13:03:02Z","timestamp":1617627782000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["DRESS induced by amoxicillin-clavulanate in two pediatric patients confirmed by lymphocyte toxicity assay"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2675-173X","authenticated-orcid":false,"given":"Arun","family":"Dhir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasandeep","family":"Kular","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelbaset A.","family":"Elzagallaai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Carleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Rieder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Mak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,5]]},"reference":[{"issue":"5","key":"535_CR1","doi-asserted-by":"publisher","first-page":"693.e1","DOI":"10.1016\/j.jaad.2013.01.033","volume":"68","author":"Z Husain","year":"2013","unstructured":"Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part I clinical perspectives. J Am Acad Dermatol. 2013;68(5):693.e1-693.e14.","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"535_CR2","doi-asserted-by":"publisher","first-page":"165","DOI":"10.2500\/aap.2012.33.3498","volume":"33","author":"KG Blumenthal","year":"2012","unstructured":"Blumenthal KG, Patil SU, Long AA. The importance of vancomycin in drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. Allergy Asthma Proc. 2012;33(2):165\u201371.","journal-title":"Allergy Asthma Proc"},{"issue":"2","key":"535_CR3","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/j.jaip.2018.08.013","volume":"7","author":"AR Wolfson","year":"2019","unstructured":"Wolfson AR, Zhou L, Li Y, Phadke NA, Chow OA, Blumenthal KG. Drug Reaction with eosinophilia and systemic symptoms (dress) syndrome identified in the electronic health record Allergy Module. J Allergy Clin Immunol Pract. 2019;7(2):633\u201340.","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"2","key":"535_CR4","doi-asserted-by":"publisher","first-page":"e162","DOI":"10.1111\/pde.12803","volume":"33","author":"S Sasidharanpillai","year":"2016","unstructured":"Sasidharanpillai S, Sabitha S, Riyaz N, Binitha MP, Muhammed K, Riyaz A, et al. Drug reaction with Eosinophilia and systemic symptoms in children: a prospective study. Pediatr Dermatol. 2016;33(2):e162\u20135.","journal-title":"Pediatr Dermatol"},{"issue":"6","key":"535_CR5","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.3390\/ijms18061243","volume":"18","author":"Y-T Cho","year":"2017","unstructured":"Cho Y-T, Yang C-W, Chu C-Y. Drug reaction with eosinophilia and systemic symptoms (DRESS): an interplay among drugs, viruses, and immune system. Int J Mol Sci. 2017;18(6):1243.","journal-title":"Int J Mol Sci."},{"issue":"6","key":"535_CR6","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1016\/S0009-9236(98)90093-5","volume":"63","author":"GL Kearns","year":"1998","unstructured":"Kearns GL, Wheeler JG, Rieder MJ, Reid J. Serum sickness-like reaction to cefaclor: lack of in vitro cross-reactivity with loracarbef. Clin Pharmacol Ther. 1998;63(6):686\u201393.","journal-title":"Clin Pharmacol Ther"},{"issue":"6","key":"535_CR7","doi-asserted-by":"publisher","first-page":"273","DOI":"10.23822\/EurAnnACI.1764-1489.47","volume":"50","author":"GT Chua","year":"2018","unstructured":"Chua GT, Rosa Duque JS, Chong PCY, Lee PPW, Lau YL, Ho MHK. Paediatric case series of drug reaction with eosinophilia and systemic symptoms (DRESS): 12-year experience at a single referral centre in Hong Kong and the first reported use of infliximab. Eur Ann Allergy Clin Immunol. 2018;50(6):273\u20136.","journal-title":"Eur Ann Allergy Clin Immunol"},{"issue":"5","key":"535_CR8","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/BF03256387","volume":"14","author":"AA Elzagallaai","year":"2010","unstructured":"Elzagallaai AA, Jahedmotlagh Z, Del Pozzo-Maga\u00f1a BR, Knowles SR, Prasad AN, Shear NH, et al. Predictive value of the lymphocyte toxicity assay in the diagnosis of drug hypersensitivity syndrome. 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