Outcomes of Cyclosporine Treatment in Pediatric Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): A Retrospective Cohort Analysis.

Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) is a rare but severe hypersensitivity reaction. This retrospective cohort study compared the efficacy of systemic corticosteroids, the current first-line therapy, with cyclosporine, an emerging alternative therapy, in pediatric DReSS patients. We analyzed 14 cases of pediatric patients (<18 years) admitted to The Hospital for Sick Children between January 2016 and September 2023. Five patients received cyclosporine, while nine were treated with systemic corticosteroids. Cyclosporine treatment was associated with shorter hospital stays (median 6 days vs. 9 days) and faster normalization of alanine aminotransferase levels (25.0 days vs. 40.0 days) compared to corticosteroids. While cyclosporine was well-tolerated, corticosteroid therapy was linked to adverse events, including corticosteroid-induced diabetes (n=2), disease flares during tapering (n=3), and the need for treatment intensification (n=2). These findings suggest that cyclosporine may be a promising alternative for managing pediatric DReSS.