A severity grading system of food-induced acute allergic reactions to avoid the delay of epinephrine administration

Abstract

BackgroundSubstantial discrepancies among anaphylaxis severity scores may delay epinephrine administration. ObjectiveThe study aims to develop a transparent severity grading system of food-induced acute allergic reactions with a decision model for epinephrine use. MethodsThe natural course of 315 acute food-induced allergic reactions in children hospitalized at the Allergology department between May 2016 and July 2019 owing to follow-up treatment and allergy diagnostics was evaluated. The severity of episodes was classified according to the 5 most accepted grading systems. The interrater reliability of classification between anaphylaxis severity scores was assessed. All symptoms were grouped into a heat map according to their real-life incidence and clinical relevance. Based on the heat map analysis, a severity grading system of food-induced acute allergic reactions in children with the epinephrine administration decision model was created. ResultsData from 259 food-induced anaphylaxis episodes in 157 children were included in the analysis. Comparing the grading systems, we observed a 24.7% to 70.2% disagreement between severity scores. The heat map illustrated a strong association between 29 symptoms and their categorization. A new severity grading system was developed and a 2-stage decision model was proposed: “epinephrine yes” (any rapidly progressing symptoms, even mild ones or from 1 organ system; any symptoms from more than 1 organ system; or every grade of anaphylaxis), and “epinephrine available and prepared to use” (nonprogressing mild systemic allergic reaction from 1 system area only; no anaphylaxis). ConclusionA new severity grading system of food-induced acute allergic reactions in children could serve as a clinical tool for health care professionals to avoid epinephrine administration delay.