Timothy E Dribin1, David Schnadower2, Jonathan M Spergel3, Ronna L Campbell4, Marcus Shaker5, Mark I Neuman6, Kenneth A Michelson6, Peter S Capucilli7, Carlos A Camargo8, David C Brousseau9, Susan A Rudders10, Amal H Assa'ad11, Kimberly A Risma11, Mariana Castells12, Lynda C Schneider10, Julie Wang13, Juhee Lee3, Rakesh D Mistry14, David Vyles9, Michael Pistiner15, John K Witry16, Yin Zhang17, Hugh A Sampson13. 1. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: Timothy.Dribin@cchmc.org. 2. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. 3. Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa. 4. Department of Emergency Medicine, Mayo Clinic, Rochester, Minn. 5. Dartmouth Geisel School of Medicine, Hanover, NH; Dartmouth-Hitchcock Medical Center, Hanover, NH. 6. Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. 7. Rochester Regional Health, Rochester, NY. 8. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 9. Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee. 10. Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass. 11. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 12. Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 13. Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY. 14. Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora. 15. Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 16. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 17. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BACKGROUND: There is no widely adopted severity grading system for acute allergic reactions, including anaphylactic and nonanaphylactic reactions, thus limiting the ability to optimize and standardize management practices and advance research. OBJECTIVE: The aim of this study was to develop a severity grading system for acute allergic reactions for use in clinical care and research. METHODS: From May to September 2020, we convened a 21-member multidisciplinary panel of allergy and emergency care experts; 9 members formed a writing group to critically appraise and assess the strengths and limitations of prior severity grading systems and develop the structure and content for an optimal severity grading system. The entire study panel then revised the grading system and sought consensus by utilizing Delphi methodology. RESULTS: The writing group recommended that an optimal grading system encompass the severity of acute allergic reactions on a continuum from mild allergic reactions to anaphylactic shock. Additionally, the severity grading system must be able to discriminate between clinically important differences in reaction severity to be relevant in research while also being intuitive and straightforward to apply in clinical care. Consensus was reached for all elements of the proposed severity grading system. CONCLUSION: We developed a consensus severity grading system for acute allergic reactions, including anaphylactic and nonanaphylactic reactions. Successful international validation, refinement, dissemination, and application of the grading system will improve communication among providers and patients about the severity of allergic reactions and will help advance future research.
BACKGROUND: There is no widely adopted severity grading system for acute allergic reactions, including anaphylactic and nonanaphylactic reactions, thus limiting the ability to optimize and standardize management practices and advance research. OBJECTIVE: The aim of this study was to develop a severity grading system for acute allergic reactions for use in clinical care and research. METHODS: From May to September 2020, we convened a 21-member multidisciplinary panel of allergy and emergency care experts; 9 members formed a writing group to critically appraise and assess the strengths and limitations of prior severity grading systems and develop the structure and content for an optimal severity grading system. The entire study panel then revised the grading system and sought consensus by utilizing Delphi methodology. RESULTS: The writing group recommended that an optimal grading system encompass the severity of acute allergic reactions on a continuum from mild allergic reactions to anaphylactic shock. Additionally, the severity grading system must be able to discriminate between clinically important differences in reaction severity to be relevant in research while also being intuitive and straightforward to apply in clinical care. Consensus was reached for all elements of the proposed severity grading system. CONCLUSION: We developed a consensus severity grading system for acute allergic reactions, including anaphylactic and nonanaphylactic reactions. Successful international validation, refinement, dissemination, and application of the grading system will improve communication among providers and patients about the severity of allergic reactions and will help advance future research.
Authors: Timothy E Dribin; David Schnadower; Julie Wang; Carlos A Camargo; Kenneth A Michelson; Marcus Shaker; Susan A Rudders; David Vyles; David B K Golden; Jonathan M Spergel; Ronna L Campbell; Mark I Neuman; Peter S Capucilli; Michael Pistiner; Mariana Castells; Juhee Lee; David C Brousseau; Lynda C Schneider; Amal H Assa'ad; Kimberly A Risma; Rakesh D Mistry; Dianne E Campbell; Margitta Worm; Paul J Turner; John K Witry; Yin Zhang; Brad Sobolewski; Hugh A Sampson Journal: J Allergy Clin Immunol Date: 2021-08-12 Impact factor: 10.793
Authors: R Sharon Chinthrajah; Stacie M Jones; Edwin H Kim; Scott H Sicherer; Wayne Shreffler; Bruce J Lanser; Negin Atri; Denise C Babineau; Daniel C Adelman; Ahmar Iqbal; Susan L Limb; Amanda K Rudman Spergel; Alkis Togias; Robert A Wood Journal: J Allergy Clin Immunol Date: 2022-01-11 Impact factor: 14.290
Authors: Montserrat Fernández-Rivas; Ismael Gómez García; Alejandro Gonzalo-Fernández; Manuel Fuentes Ferrer; Sabine Dölle-Bierke; Guadalupe Marco-Martín; Barbara K Ballmer-Weber; Riccardo Asero; Simona Belohlavkova; Kirsten Beyer; Frédéric de Blay; Michael Clausen; Mareen R Datema; Ruta Dubakiene; Kate E C Grimshaw; Karin Hoffmann-Sommergruber; Jonathan O'B Hourihane; Monika Jedrzejczak-Czechowicz; André C Knulst; Tanya Kralimarkova; Thuy-My Le; Nikolaos G Papadopoulos; Todor A Popov; Lars K Poulsen; Ashok Purohit; Suranjith L Seneviratne; Angela Simpson; Atanasios Sinaniotis; Mirjana Turkalji; Sonia Vázquez-Cortés; Rosialzira N Vera-Berrios; Antonella Muraro; Margitta Worm; Graham Roberts; Ronald van Ree; Cristina Fernández-Pérez; Paul J Turner; Elizabeth N Clare Mills Journal: Allergy Date: 2021-11-12 Impact factor: 14.710
Authors: Alma Yuste-Montalvo; Sergio Fernandez-Bravo; Tamara Oliva; Carlos Pastor-Vargas; Diana Betancor; María José Goikoetxea; José Julio Laguna; Juan Antonio López; Gloria Alvarez-Llamas; Javier Cuesta-Herranz; Marta Martin-Lorenzo; Vanesa Esteban Journal: Front Immunol Date: 2021-06-25 Impact factor: 7.561