Anaphylaxis severity grade, during oral food challenges, assessed by five different classifications

Area of Science:

• Allergy and Immunology
• Clinical Medicine
• Public Health

Background:

• Anaphylaxis definition is established, but severity grading remains debated.
• Discrepancies in anaphylaxis severity scoring systems hinder consistent diagnosis and management.
• The World Health Organization's International Classification of Diseases, 11th Revision (ICD-11) provides a standardized reference.

Purpose of the Study:

• To evaluate discrepancies in anaphylaxis severity scoring systems.
• To compare anaphylactic versus non-anaphylactic reactions following oral food challenges (OFC).
• To utilize ICD-11 as the primary reference for classifying anaphylaxis severity.

Main Methods:

• Retrospective observational study at University Hospital of Montpellier, France (2018-2022).
• Inclusion of patients with positive oral food challenges (OFC).
• Classification of reaction severity using 5 different systems and comparison with ICD-11 criteria.

Main Results:

• Out of 235 patients with positive OFC, 143 (60.9%) were classified as anaphylaxis per ICD-11.
• Complete concordance across all severity classifications was observed in only 5.6% of patients.
• Classifications demonstrated high sensitivity (99.3%-100%) but variable specificity (67.4%-93.5%), indicating significant discrepancies.

Conclusions:

• Existing anaphylaxis severity scoring systems require refinement due to notable discrepancies.
• Dissemination of unified diagnostic criteria, such as ICD-11, is crucial to prevent underdiagnosis.
• Standardized criteria ensure appropriate and timely management for all patients experiencing allergic reactions.