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A severity grading system of food-induced acute allergic reactions to avoid the delay of epinephrine administration
Lukasz Blazowski1, Pawel Majak2, Ryszard Kurzawa3
1Department of Allergology and Pulmonology, National Research Institute of Tuberculosis and Lung Diseases, Rabka-Zdroj, Poland; Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland; Pediatric and Allergology Department, Specialist Hospital, Jaslo, Poland.
Insights
Discrepancies in anaphylaxis severity scores can delay epinephrine. This study developed a new grading system and decision model for food-induced allergic reactions in children to ensure timely treatment.
Area of Science:
- Allergy and Immunology
- Pediatric Emergency Medicine
- Clinical Decision Support
Background:
- Existing anaphylaxis severity scores show significant discrepancies, potentially delaying critical epinephrine administration.
- Accurate and timely assessment of food-induced allergic reactions is crucial for effective management in children.
Purpose of the Study:
- To develop a transparent severity grading system for food-induced acute allergic reactions in children.
- To create a decision model to guide appropriate epinephrine use.
Main Methods:
- Evaluated 315 food-induced allergic reactions in children, classifying severity using 5 established grading systems.
- Assessed interrater reliability of severity scores and analyzed symptom incidence and clinical relevance using a heat map.
- Developed a novel severity grading system and a 2-stage decision model for epinephrine administration.
Main Results:
- Analysis of 259 food-induced anaphylaxis episodes revealed 24.7% to 70.2% disagreement between existing severity scores.
- A heat map effectively associated 29 symptoms with their categorization.
- A new 2-stage decision model was proposed: 'epinephrine yes' for progressing or multi-system symptoms, and 'epinephrine available' for mild, non-progressing reactions.
Conclusions:
- A new severity grading system for pediatric food-induced anaphylaxis can serve as a clinical tool.
- This system aims to improve healthcare professionals' ability to avoid delays in epinephrine administration.
- Standardizing assessment can lead to more consistent and timely management of severe allergic reactions.
Background:
Substantial discrepancies among anaphylaxis severity scores may delay epinephrine administration.
Objective:
The study aims to develop a transparent severity grading system of food-induced acute allergic reactions with a decision model for epinephrine use.
Methods:
The 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.
Results:
Data 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).
Conclusion:
A 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.
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