WAO/EAAIC criteria (19, 24)
1. Acute onset of an illness (minutes to several hours) with simultaneous involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritus or flushing, swollen lips-tongue-uvula) AND at least one of the following:
a. Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
b. Reduced BP or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence)
c. Severe gastrointestinal symptoms (e.g., severe crampy abdominal pain, repetitive vomiting), OR
2. Acute onset of hypotension or bronchospasm or laryngeal involvement after exposure to a known or highly probable allergen for that patient (minutes to several hours), even in the absence of typical skin involvement. OR
3. Danger signs for SCAR:
a. Tiny vesicles or crusts, grey‐violaceous or dusky color of lesions, painful or burning skin and/or mucosa in addition to fever and malaise, hemorrhagic erosions of mucous membranes and skin detachment (SJS/TEN)
b. Exanthema with pustules (AGEP)
c. Purpura (vasculitis)
d. Macules/papules together with non-cutaneous organ involvement; progression to more than 50% of the body surface area, deviating laboratory values (differential blood count, liver and kidney parameters) (DRESS).
e. Facial oedema, edematous and infiltrated skin inflammation. Acute fever of 38.5°C and higher. (AGEP/DRESS)
Note: if an MPE meets the symptom or CIOMS-criteria for a severe reaction, it should be considered as such.
1. Symptom(s)/sign(s) from 1 organ system present:
a. Cutaneous: Urticaria, erythema-warmth, pruritus, tingling, itching of the lips.
b. Upper respiratory: Nasal symptoms (e.g., sneezing, rhinorrhea, nasal pruritus, and/or nasal congestion), Throat-clearing (itchy throat), Cough not related to bronchospasm.
c. Conjunctival: Erythema, pruritus, or tearing. OR
2. Maculopapular exanthema without organ involvement. OR
3. Other: Nausea, Metallic taste
Bron: SWAB guideline for the approach to suspected Antibiotic Allergy, 2022. Richtlijn downloaden: 192 (swab.nl)