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Indeling type allergie

Type of reaction according to the Gell and Coombs classification

Type of allergy (relative frequency)



For classification of severity of symptoms see SWAB richtlijn table 8


Chronology of onset


Type I



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



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



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)



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)



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)



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


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)



CD4 and CD8 T cells implicated

Fever, rash, peripheral blood eosinophilia, lymphadenopathy, organ involvement


2-8 weeks

Steven Johnson Syndrome and toxic epidermal necrolyses (SJS/TEN)



CD8 cytotoxic T cells

Rash with detachment, mucosal lesions, fever, upper respiratory tract symptoms

4 -28 days

Acute generalized exanthematous pustulosis (AGEP)




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.







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