Severity grading system for acute allergic reactions: A multidisciplinary Delphi study

• Published in: Journal of allergy and clinical immunology 2021-07, Vol.148 (1), p.173-181
• Main Authors: Dribin, Timothy E., Schnadower, David, Spergel, Jonathan M., Campbell, Ronna L., Shaker, Marcus, Neuman, Mark I., Michelson, Kenneth A., Capucilli, Peter S., Camargo, Carlos A., Brousseau, David C., Rudders, Susan A., Assa’ad, Amal H., Risma, Kimberly A., Castells, Mariana, Schneider, Lynda C., Wang, Julie, Lee, Juhee, Mistry, Rakesh D., Vyles, David, Pistiner, Michael, Witry, John K., Zhang, Yin, Sampson, Hugh A.
• Format: Article
• Language: English
• Subjects: Allergic reactions; Allergies; Anaphylaxis; Clinical trials; Delphi; Delphi method; emergency department; Emergency medical care; Food allergies; Immunotherapy; Literature reviews; Sepsis; severity; Writing
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2021.01.003

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. The aim of this study was to develop a severity grading system for acute allergic reactions for use in clinical care and research. 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. 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. 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.