Introduction
Anaphylaxis is the most severe immediate hypersensitivity reaction,
which may potentially result in the death1. In 2013,
Panesar reported an incidence of anaphylaxis between 1.5 and 7.9 per
million inhabitants per year2. Although the number of
deaths due to anaphylaxis remains low, the frequency of anaphylactic
cases and of cases at-risk of anaphylaxis has been increasing in recent
years3.
The clinical definition of anaphylaxis remains the involvement of at
least 2 organs (cutaneous signs, respiratory symptoms, digestive
symptoms), as initially described by Ring and Messmer in
19774, and later adapted by other publications,
including the one from the World Health Organization (WHO) for the
International Classification of Diseases (ICD)-115. A
recent definition is that anaphylaxis is a serious allergic reaction
that occurs rapidly and can result in death6. As for
the classification of the severity of an anaphylactic reaction, such
topic remains a matter of debate. In recent years, several
classifications emerged, enriching the existing ones, such as those from
the ICD-117, the CoFAR one8, or
those by Sampson9, Muraro10, and
Blazowski11, and provided different scores to grade
the severity of an allergic anaphylactic reaction.
These different classifications allowed a major advancement in the
management of anaphylaxis (guiding the early use of adrenaline),
however, differences between them perpetuate a lack of uniformity in
grading different levels of severity, and consequently, potential
differences in the therapeutic approach to patients experiencing the
reaction. In clinical practice, the proliferation of classifications led
to a lack of reproducibility, as the same reaction may not receive the
same score from different classifications, which may then impact both
the timing and the choice of a specific treatment.
The objective of this study was to evaluate the possible discrepancies
in severity scoring system for anaphylaxis by applying them in patients
who presented a positive food challenge, in the Allergy Unit of a
University Hospital, using the WHO for the 11thversion of the International Classification of Diseases (ICD-11) as the
main reference.