Indeling naar type allergie:
| Type of reaction according to the Gell and Coombs classification | Type of allergy (relative frequency) | Mechanism |
Signs/symptoms For classification of severity of symptoms see SWAB guideline table 8
|
Chronology of onset |
| Antibody-mediated | ||||
| Type I |
Immediate (common) |
IgE mediated reaction based on cross linking of IgE on the surface of mast cells and subsequent degranulation. | Urticaria, angio-edema, bronchospasm and anaphylaxis | <1h typical, can be up to 6h post exposure |
| Type II |
Delayed (rare) |
Antigen binding to IgM or IgG antibody on cell surfaces or extra cellular matrix proteins. Complement mediated phagocytosis and cytotoxicity. | Cytopenia: hemolytic anemia, vasculitis, thrombocytopenia, probably medication induced pemphigus | Often < 72 hours, up to 15 days |
| Type III |
Delayed (rare) |
Deposition of antibody-antigen complexes in tissues and capillaries with subsequent inflammation (IgM, IgG, complement) | Serum sickness, fever, vasculitis (purpura, petechial) arthritis, glomerulonephritis | Days to weeks (1-3 weeks) |
| Cell-mediated (type IV) = T-cell activation by specific antigens | ||||
| Cutaneous only | ||||
| Maculopapular rash (MPE) |
Delayed (common) |
Eosinophilic infiltration or infiltration of cytotoxic T cells | Morbilliform rash, eosinophilia | Days to weeks, typically 4-14 days |
| Symmetrical drug related intertriginous and flexural exanthem (SDRIFE) |
Delayed (rare) |
Infiltration of cytotoxic T cells | Similar to MPE, with involvement of the gluteal and intertriginous areas and symmetry of lesions. | Up to 7 days |
| Fixed drug eruption (FDE) |
Delayed (rare) |
IFN gamma and cytotoxic granules released by CD8 T cells | Painful/ burning erythematous or edematous round plaques with gray/dusky center at same sites (lip, tongue, face, genitals) |
Days to weeks, minutes upon re-challenge
|
| Contact dermatitis | Delayed | Monocytic inflammation | Erythema and edema with vesicles or bullae | Days to weeks |
| Primary single organ | ||||
| Acute interstitial nephritis | Delayed (rare) | CD4/ monocyte immune injury | Rash, acute kidney injury, white cell casts in urinary sediment, eosinophilia | 3 days-4 weeks |
| Liver injury | Delayed (rare) | CD4 then CD8 T cell activation and TNFα with perforin | Transaminitis (cholestatic or mixed), sometimes rash, fever or eosinophilia | 5 days-12 weeks |
| Severe Cutaneous Adverse Reactions (SCAR), involve systemic symptoms | ||||
| Drug reaction eosinophilia and systemic symptoms syndrome (DRESS) |
Delayed (rare) |
CD4 and CD8 T cells implicated |
Fever, rash, peripheral blood eosinophilia, lymphadenopathy, organ involvement (liver/kidney) |
2-8 weeks |
| Steven Johnson Syndrome and toxic epidermal necrolyses (SJS/TEN) |
Delayed (rare) |
CD8 cytotoxic T cells | Rash with detachment, mucosal lesions, fever, upper respiratory tract symptoms | 4 -28 days |
| Acute generalized exanthematous pustulosis (AGEP) |
Delayed (rare)
|
T cells via IL-8 and granulocyte-macrophage colony stimulating factor | Acute pustular eruption with widespread non-follicular sterile pustules with fever, facial edema, neutropenia, oral involvement |
1-12 days
|
| Other SCARs e.g. drug induced IgA dermatosis, etc. |
Delayed (rare) |
diverse | diverse | variable |
Bron: SWAB guideline for the approach to suspected Antibiotic Allergy, 2022. Richtlijn downloaden: 192 (swab.nl)