A PERSONALIZED approach to managing tuberculosis drug reaction with eosinophilia and systemic symptoms, or TB DRESS, is gaining momentum as clinicians face increasing challenges in treating tuberculosis in immunocompromised populations, particularly people living with HIV.
According to a new review, the global rise in TB incidence is amplifying attention on TB DRESS, a serious adverse reaction that complicates treatment during a critical window. The condition presents with systemic symptoms and organ involvement and often leads to interruptions in first-line TB therapy. This is particularly detrimental in patients with comorbid immunosuppression, where treatment continuity is essential.
Key management strategies currently include the timely cessation of the suspected drug, provision of supportive care, and use of topical corticosteroids. While systemic corticosteroids have traditionally played a role in managing severe drug reactions, their routine use in TB DRESS remains controversial. The review highlights that favorable outcomes have been achieved using only topical treatments, especially in TB and HIV co-infected patients, where limiting further immunosuppression is beneficial.
Innovative approaches are beginning to reshape the treatment landscape. These include shortened TB regimens and the use of sequential additive drug challenge, or SADC, combined with single-dose intravenous corticosteroids to reduce the risk of adverse reactions during reintroduction. Although still in early use, desensitization protocols are also being explored as a potential pathway to reintroduce critical TB medications safely.
Despite these advancements, TB DRESS continues to present complex management challenges. Patients often require prolonged hospital stays, and healthcare systems face high associated costs. These factors underscore the need for more efficient and tailored solutions.
The authors advocate for a transition toward truly personalized treatment frameworks. Future efforts are likely to focus on integrating clinical evaluation with genomic and in-vitro tools to stratify patient risk and guide the safe reintroduction of TB medications. As TB and HIV co-infection remains prevalent in many parts of the world, improving outcomes for this vulnerable group is an urgent priority.
Reference:
Peter J et al. Management of patients with tuberculosis medication-induced drug reaction with eosinophilia and systemic symptoms. Curr Opin Allergy Clin Immunol. 2025. doi:10.1097/ACI.0000000000001084. [Online ahead of print]
