Severity grading system for acute allergic reactions: A multidisciplinary Delphi study - 05/07/21
, David Schnadower, MD, MPH a, b, Jonathan M. Spergel, MD, PhD c, Ronna L. Campbell, MD, PhD d, Marcus Shaker, MD, MSc e, f, Mark I. Neuman, MD, MPH g, h, Kenneth A. Michelson, MD, MPH g, h, Peter S. Capucilli, MD i, Carlos A. Camargo, MD, DrPH j, David C. Brousseau, MD, MS k, Susan A. Rudders, MD, MS h, l, Amal H. Assa’ad, MD b, m, Kimberly A. Risma, MD, PhD b, m, Mariana Castells, MD, PhD n, Lynda C. Schneider, MD h, l, Julie Wang, MD o, Juhee Lee, MD c, Rakesh D. Mistry, MD, MS p, David Vyles, DO, MS k, Michael Pistiner, MD, MMSc q, John K. Witry, MS a, Yin Zhang, MS r, Hugh A. Sampson, MD oAbstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : Allergic reactions, anaphylaxis, Delphi, emergency department, severity
Abbreviations used : GCS, MAP, NIAID/FAAN
Plan
| Supported by the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center. |
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| Disclosure of potential conflict of interest: D. Schnadower receives funding from the National Institutes of Health (NIH). J. M. Spergel has grant support from DBV Technology, AImmune, and the NIH; in addition, he has consulted for Kaleo. R. L. Campbell has been a peer reviewer for EB Medicine, a consultant for Bryn Pharma, and an author for UpToDate. M. Shaker has a brother who is chief executive officer of Altrix Medical; in addition, he is a member of the Joint Task Force on Practice Parameters, and he serves as an editorial board member for the Journal of Allergy and Clinical Immunology: In Practice; Annals of Allergy, Asthma, and Immunology, and the Journal of Food Allergy. K. A. Michelson receives funding from AHRQ. C. A. Camargo has consulted for Bryn Pharma and Kaleo. D. C. Brousseau receives funding from the NIH and the Maternal and Child Health Bureau. A. H. Assa’ad has research grants from the NIH, Aimmune, DBV technologies, Astellas, AbbVie, and Sanofi. M. Castells is the Brigham and Women's Hospital principal investigator for the PIONEER BluPrint Clinical Trial for Indolent Systemic Mastocytosis. L. C. Schneider has received research support from Regeneron Pharmaceuticals, DBV Technologies, Pfizer, and Genentech; has consulted for Aimmune Therapeutics; and is on the medical advisory board of FARE (Food Allergy Research and Education). J. Wang receives research support from the National Institute of Allergy and Infectious Disease (NIAID), Aimmune, DBV Technologies, and Regeneron, as well as consultancy fees from, ALK-Abelló, DBV Technologies, and Genentech. R. Mistry receives funding from the NIAID. M. Pistiner has served on advisory boards of DBV Technologies, Kaleo, and Novartis; in addition, he has received research funding from Kaleo and programming funding from DBV Technologies, and he is cofounder of AllergyHome and Allergy Certified Training. H. A. Sampson receives funding to his institution for grants from the NIH/NIAID; in addition, he is employed part-time by and has received stock options from DBV Technologies. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 148 - N° 1
P. 173-181 - juillet 2021 Retour au numéro
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