Drug reaction with eosinophilia and systemic symptoms (DRESS) and drug-induced liver injury (DILI) can hamper therapeutic strategy, contribute to multiple drug resistance and serious public health burden. Diagnosis (including allergy assessment) and management of these two severe hypersensitivity reactions in clinical practice are somewhat difficult and published scientific evidence is rather weak and limited. The first step is always represented by stopping all anti-tuberculosis (TB) drugs, treating reaction with systemic corticosteroids, and identifying the offending drug, even if it is often complicated by the patient's simultaneous intake of antibiotics. Patch tests and in vitro tests, such as lymphocyte transformation test, could bridge this diagnostic gap, but the available data are scarce and their sensitivity low. The re-challenge test is often necessary but places patients at risk for serious adverse reactions. The desensitization protocols are quite varied and not universally accepted. In this narrative review, we provide an update to the literature data on the management of DRESS and DILI with particular attention to the allergological work-up in the last decade.

中文翻译：

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抗结核药物引起的非起泡全身严重反应：10年（2012-2022）文献综述。

嗜酸性粒细胞增多和全身症状（DRESS）和药物性肝损伤（DILI）的药物反应可能会阻碍治疗策略，导致多重耐药性和严重的公共卫生负担。在临床实践中，这两种严重超敏反应的诊断（包括过敏评估）和处理有些困难，并且已发表的科学证据相当薄弱和有限。第一步始终是停止使用所有抗结核 (TB) 药物，用全身性皮质类固醇治疗反应，并识别出致病药物，即使患者同时服用抗生素通常会使情况变得复杂。斑贴试验和体外试验（例如淋巴细胞转化试验）可以弥补这一诊断差距，但可用数据稀缺且敏感性较低。重新激发试验通常是必要的，但会使患者面临严重不良反应的风险。脱敏方案多种多样，并未得到普遍接受。在这篇叙述性综述中，我们提供了有关 DRESS 和 DILI 管理的文献数据的更新，特别关注过去十年的过敏学检查。