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

Published: January 18, 2021

Acute allergic reactions may occur following exposure to a wide variety of allergens (e.g. foods, medications, biological compounds, plants, venoms) and in a broad range of settings (e.g. home, school, recreational, healthcare). From 2008 to 2016, there were over 400,000 emergency department (ED) visits for anaphylaxis, during which time visits doubled across all ages and tripled among children. The societal burden of acute allergic reactions (including anaphylaxis) on patients, families, and the US healthcare system is considerable. Direct medical costs from food allergies alone total $4.3 billion dollars annually, including average individual direct medical costs of $2,081. Although severity grading systems have been developed in the past, they have not been widely implemented, thereby hindering standardization of clinical practice and research efforts.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), a panel of 21 experts in Emergency Medicine, Pediatrics and Allergy Immunology led by Dr. Timothy Dribin from Cincinnati Children’s Hospital developed a consensus severity grading system for acute allergic reactions, including anaphylactic and non-anaphylactic reactions. Nine 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 utilizing Delphi methodology. The grading system is organized into a grading and sub-grading system to ensure that it is intuitive and straightforward to apply in clinical care, while allowing clinicians and researchers the ability to account for the entirety of symptoms within each organ system. Consensus was reached for all elements of the proposed severity grading system.

Successful 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 by standardizing reaction descriptors and outcomes.  

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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