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Assigning severity in food-induced allergic reactions: much room for improvement

Published: July 18, 2021

Numerous scoring systems are used to assign severity to food-induced allergic reactions, but many have significant limitations, including an inability to discriminate between non-anaphylaxis reactions of different severities. For food allergy, severity assignment is important, as it might be used to diagnose anaphylaxis and guide treatment or evaluate the response to allergen immunotherapy.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Stafford and colleagues report the results of a global exercise performed through the European Union-funded iFAAM (Integrated Approaches to Food Allergen and Allergy Management) collaboration. In contrast to most surveys which are prone to user-scale bias, the authors used Best-Worst scaling (BWS) methodology in which respondents were asked to rate the severity of a number of real-world case vignettes, by selecting the two which, in their opinion, reflected the maximum difference in severity. Responses were then modeled using a computer algorithm and a preference score (representing severity) determined for each scenario. These scores were then compared to the same case vignettes evaluated with existing published scoring systems.

The authors demonstrated significant differences between the severity assignment through the BWS modeling, and existing severity scores. For example, one common issue was the use of a scoring system not originally intended for use in food allergy, which gives undue prominence to certain symptoms (such as vomiting) which are arguably less indicative of severity in food-induced reactions. The authors conclude that current scoring systems poorly discriminate against less severe reactions, and often overestimate their severity. This can result in greater anxiety on the part of allergic patients and their families. The authors highlight a number of areas where severity assignment could be improved, to better reflect severity and improve communication between patients and healthcare professionals.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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