Grading the severity of anaphylaxis

Abstract

Purpose of reviewDespite no global consensus on a definition of anaphylaxis, there is increasing recognition that just as allergic reactions lie on a spectrum of severity, the same is for anaphylaxis. A variety of severity scores exist in the literature. We review the approaches taken to develop these scores, and their relative advantages and disadvantages.Recent findingsThere have been four recent comparisons of published severity scores. All have highlighted the heterogeneity between scoring systems, and the lack of transferability from one approach to another. Notably, only one score has been developed using a data-driven approach, and none has undergone formal and comprehensive validation.SummaryIt is unclear whether a single severity score is achievable, or indeed desirable. If the aim is to guide management of acute reactions, then assignment of severity is not only unnecessary but might delay treatment and cause harm. Severity scores are needed in the research setting, but require an approach which can discriminate between reactions of similar but nonidentical severity (particularly, nonanaphylaxis reactions). Any approach should be fit for purpose, informed by patient and clinician experience, and ideally be data-driven to minimize subjective bias and facilitate objective validation.

Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee

“…However, numerous severity grading systems for allergic reactions have been described in the literature. 1 , 2 Many of these systems were originally developed to grade reactions of a specific allergen type (eg, venom) and are not necessarily appropriate when applied to other allergen types. For example, the grading systems proposed by Ring and Messmer 3 and Mueller 4 were originally intended to grade allergic reactions to drug- and venom-induced reactions respectively.…”

Evaluating Hymenoptera Venom Allergy Severity: A Data-Centric Comparison of Grading Instruments

“…They differ significantly in their intended purpose (e.g., clinical decision aid, trials), setting (e.g., field reactions, graded challenge, immunotherapy), target population (e.g., children, adults, or both), and culprit allergen, leading to limited adoption by clinicians and researchers alike, with regional, national and even department-based preferences and habits dictating which systems are used, if any at all. An exhaustive summary and comparison of the most commonly used grading instruments can be found in recently published literature, reflecting the increasingly urgent calls for the adoption of a universal grading instrument [2][3][4][5][6].…”

Tablet allergen immunotherapy: the anaphylaxis issue

“…It is well-known fact that allergic patients, depending on different immunological and clinical characteristics, significantly differ from one another. 7 In particular, there are allergy patients who may tolerate very low doses of an allergen, while others can tolerate very high doses of the same allergen. In addition, some subjects are only sensitized but not allergic.…”