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

Acute Disease Anaphylaxis / pathology Consensus Delphi Technique Emergency Medical Services / methods Humans Hypersensitivity / pathology Severity of Illness Index
Allergic reactions Delphi anaphylaxis emergency department severity

Journal

The Journal of allergy and clinical immunology
ISSN: 1097-6825
Titre abrégé: J Allergy Clin Immunol
Pays: United States
ID NLM: 1275002

Informations de publication

Date de publication:
07 2021
Historique:
received: 29 09 2020
revised: 29 12 2020
accepted: 08 01 2021
pubmed: 22 1 2021
medline: 13 10 2021
entrez: 21 1 2021
Statut: ppublish

Résumé

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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.jaci.2021.01.003 PMID: 33476673 PMC: PMC8273088
pubmed: 33476673
pii: S0091-6749(21)00047-6
doi: 10.1016/j.jaci.2021.01.003
pmc: PMC8273088
mid: NIHMS1682583
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

173-181

Subventions

Organisme : AHRQ HHS
ID : K08 HS026503
Pays : United States

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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Auteurs

Timothy E Dribin (TE)

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: Timothy.Dribin@cchmc.org.

David Schnadower (D)

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Jonathan M Spergel (JM)

Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa.

Ronna L Campbell (RL)

Department of Emergency Medicine, Mayo Clinic, Rochester, Minn.

Marcus Shaker (M)

Dartmouth Geisel School of Medicine, Hanover, NH; Dartmouth-Hitchcock Medical Center, Hanover, NH.

Mark I Neuman (MI)

Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.

Kenneth A Michelson (KA)

Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.

Peter S Capucilli (PS)

Rochester Regional Health, Rochester, NY.

Carlos A Camargo (CA)

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

David C Brousseau (DC)

Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee.

Susan A Rudders (SA)

Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass.

Amal H Assa'ad (AH)

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Kimberly A Risma (KA)

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Mariana Castells (M)

Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Lynda C Schneider (LC)

Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass.

Julie Wang (J)

Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.

Juhee Lee (J)

Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa.

Rakesh D Mistry (RD)

Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora.

David Vyles (D)

Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee.

Michael Pistiner (M)

Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

John K Witry (JK)

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Yin Zhang (Y)

Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Hugh A Sampson (HA)

Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie aigüe › Severity grading system for acute allergic...
questionsmedicales.fr › Maladies du système immunitaire › Hypersensibilité › Hypersensibilité immédiate › Anaphylaxie › Severity grading system for acute allergic...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › Severity grading system for acute allergic...
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Méthode Delphi › Severity grading system for acute allergic...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Severity grading system for acute allergic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Severity grading system for acute allergic...
questionsmedicales.fr › Maladies du système immunitaire › Hypersensibilité › Severity grading system for acute allergic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes de santé › Indicateurs d'état de santé › Acuité des besoins du patient › Indice de gravité de la maladie › Severity grading system for acute allergic...