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Wat is het advies bij een gerapporteerde non-ß-lactam allergie?



Quality of evidence

58. We recommend avoiding re-exposure to the culprit non-ß-lactam and all other non-ß-lactams within the same class when the index reaction was severe.



59. We suggest that, in general (see next recommendation), when the index reaction was non-severe, the culprit non-ß-lactam and all other non-ß-lactams within the same class can be re-introduced in a controlled setting*.



60. For quinolones, we recommend that if the index reaction was generalized urticaria, the culprit quinolone and all other quinolones should be avoided (because of potential direct mast cell release mechanism) and discussed in a multidisciplinary team**.




*A clinical setting, in which the patient is observed, with trained personnel, where rapid and adequate treatment can be administered when an allergic reaction occurs. Of note: in case of a non-severe delayed type reaction ‘a controlled setting’ means adequate instruction of the patient and follow-up are warranted because delayed type reactions may manifest days after exposure.
**An expert team that consists of an infectious diseases specialist and/ or microbiologist, pharmacist and if available an allergist. The risk of side effects and benefits of use of proper antibiotic should be balanced against each other followed by shared decision making with the patient.


Bron:  SWAB guideline for the approach to suspected Antibiotic Allergy, 2022.  Richtlijn downloaden: 192 (swab.nl)