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Welke patiënten met een gerapporteerde ß-lactam allergie kunnen toch dezelfde penicilline krijgen?

Recommendation

Strength

Quality of evidence

6. We suggest that the time that has elapsed since the index reaction should be factored in the probability that an allergy will occur upon re-exposure to the culprit drug: the longer ago, the smaller the chance of an allergic reaction occurring.

Weak

Low

7. We suggest that patients with suspected* non-severe, immediate type index reactions that occurred >5 years ago, can receive a therapeutic dose of the culprit beta-lactam antibiotic in a controlled setting**.

Weak

Low

8. We recommend that patients with suspected* non-severe, immediate type index reactions that occurred ≤ 5 years ago OR a suspected severe immediate type index reaction irrespective of time elapsed, should be referred for formal allergy work up before re-exposure can be considered.

Strong

Low

9. We suggest that if formal allergy testing is not available, patients with a suspected* non-severe, immediate type index reaction that occurred ≤ 5 years ago OR a suspected severe immediate type index reaction, irrespective of time elapsed, in which the indication for a specific antibiotic is vital, re-exposure could be considered if the antibiotic is administered in a controlled setting**.

Weak

Low

10. We suggest that patients with suspected* non-severe, delayed type index reactions that occurred >1 year ago can receive the culprit beta-lactam antibiotic without formal allergy testing; and to avoid exposure if this index reaction occurred <1 year ago.

Weak

Low

11. We recommend against re-exposure to the culprit drug in patients with suspected severe delayed type index reactions (Zie Indeling type allergie), irrespective of the time since the index reaction. In the absence of acceptable alternative antimicrobial treatment, the use of the culprit should be discussed in a multidisciplinary team***.

Strong

GPS

*In case of a proven allergy by formal allergy work up, handle according to the advice of the consulted allergist.
**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.
*** 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)