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

被引：97

作者：

Dribin, Timothy E. ^{[1
,4
]}

Schnadower, David ^{[1
,4
]}

Spergel, Jonathan M. ^{[5
]}

Campbell, Ronna L. ^{[6
]}

Shaker, Marcus ^{[7
,8
]}

Neuman, Mark I. ^{[9
,11
]}

Michelson, Kenneth A. ^{[9
,11
]}

Capucilli, Peter S. ^{[15
]}

Camargo, Carlos A., Jr. ^{[12
]}

Brousseau, David C. ^{[16
]}

Rudders, Susan A. ^{[10
]}

Assa'ad, Amal H. ^{[2
,4
]}

Risma, Kimberly A. ^{[2
,4
]}

Castells, Mariana ^{[14
]}

Schneider, Lynda C. ^{[10
,11
]}

Wang, Julie ^{[17
]}

Lee, Juhee ^{[5
]}

Mistry, Rakesh D. ^{[18
]}

Vyles, David ^{[16
]}

Pistiner, Michael ^{[13
]}

Witry, John K. ^{[1
]}

Zhang, Yin ^{[3
]}

Sampson, Hugh A. ^{[17
]}

机构：

[1] Cincinnati Childrens Hosp Med Ctr, Div Emergency Med, Cincinnati, OH 45229 USA

[2] Cincinnati Childrens Hosp Med Ctr, Div Allergy & Immunol, Cincinnati, OH 45229 USA

[3] Cincinnati Childrens Hosp Med Ctr, Div Biostat & Epidemiol, Cincinnati, OH 45229 USA

[4] Univ Cincinnati Coll Med, Dept Pediat, Cincinnati, OH USA

[5] Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Div Allergy & Immunol, Philadelphia, PA 19104 USA

[6] Mayo Clin, Dept Emergency Med, Rochester, MN USA

[7] Dartmouth Geisel Sch Med, Hanover, NH USA

[8] Dartmouth Hitchcock Med Ctr, Hanover, NH USA

[9] Boston Childrens Hosp, Div Emergency Med, Boston, MA USA

[10] Boston Childrens Hosp, Div Immunol, Boston, MA USA

[11] Harvard Med Sch, Dept Pediat, Boston, MA 02115 USA

[12] Harvard Med Sch, Dept Emergency Med, Massachusetts Gen Hosp, Boston, MA 02115 USA

[13] Harvard Med Sch, Dept Pediat, Massachusetts Gen Hosp, Boston, MA 02115 USA

[14] Harvard Med Sch, Brigham & Womens Hosp, Div Allergy & Clin Immunol, Dept Med, Boston, MA 02115 USA

[15] Rochester Reg Hlth, Rochester, NY USA

[16] Med Coll Wisconsin, Dept Pediat, Sect Pediat Emergency Med, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA

[17] Icahn Sch Med Mt Sinai, Div Allergy & Immunol, New York, NY 10029 USA

[18] Childrens Hosp Colorado, Sect Emergency Med, Dept Pediat, Aurora, CO USA

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY | 2021年 / 148卷 / 01期

关键词：

Allergic reactions; anaphylaxis; Delphi; emergency department; severity; INTERNATIONAL CONSENSUS DEFINITIONS; ANAPHYLACTIC REACTIONS; SEPTIC SHOCK; SEPSIS; FOOD; RISK;

D O I：

10.1016/j.jaci.2021.01.003

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

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 & nbsp;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. (J Allergy Clin Immunol 2021;148:173-81.)

引用

页码：173 / 181

页数：9

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