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Indeling type allergie

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)