World Allergy Organization Journal (Mar 2024)
Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee
- Paul J. Turner, MD, PhD,
- Ignacio J. Ansotegui, MD, PhD,
- Dianne E. Campbell, MD, PhD,
- Victoria Cardona, MD, PhD,
- Stuart Carr, MD,
- Adnan Custovic, MD, PhD,
- Stephen Durham, MD,
- Motohiro Ebisawa, MD, PhD,
- Mario Geller, MD,
- Alexei Gonzalez-Estrada, MD,
- Paul A. Greenberger, MD,
- Elham Hossny, MD, PhD,
- Carla Irani, MD,
- Agnes S.Y. Leung, MD,
- Michael E. Levin, MD, PhD,
- Antonella Muraro, MD,
- John J. Oppenheimer, MD,
- José Antonio Ortega Martell, MD,
- Guillaume Pouessel, MD,
- Manuel J. Rial, MD, PhD,
- Gianenrico Senna, MD, PhD,
- Luciana K. Tanno, MD, PhD,
- Dana V. Wallace, MD,
- Margitta Worm, MD, PhD,
- Mário Morais-Almeida, MD, PhD
Affiliations
- Paul J. Turner, MD, PhD
- National Heart Lung Institute, Imperial College London, London, UK; Corresponding author. National Heart & Lung Institute, Imperial College London, Norfolk Place, London W2 1PG, UK.
- Ignacio J. Ansotegui, MD, PhD
- Dept. Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Dianne E. Campbell, MD, PhD
- Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia; DBV Technologies, Montrouge, France
- Victoria Cardona, MD, PhD
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
- Stuart Carr, MD
- Snö Asthma & Allergy, Abu Dhabi, United Arab Emirates
- Adnan Custovic, MD, PhD
- National Heart Lung Institute, Imperial College London, London, UK
- Stephen Durham, MD
- National Heart Lung Institute, Imperial College London, London, UK
- Motohiro Ebisawa, MD, PhD
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Mario Geller, MD
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
- Alexei Gonzalez-Estrada, MD
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Paul A. Greenberger, MD
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Elham Hossny, MD, PhD
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
- Carla Irani, MD
- Hotel Dieu de France Hospital, St Joseph University, Beirut, Lebanon
- Agnes S.Y. Leung, MD
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- Michael E. Levin, MD, PhD
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
- Antonella Muraro, MD
- Department of Woman and Child Health, Food Allergy Referral Centre, Padua University Hospital, Padua, Italy
- John J. Oppenheimer, MD
- Rutgers New Jersey Medical School, Atlantic Health System Morristown, NJ, USA
- José Antonio Ortega Martell, MD
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
- Guillaume Pouessel, MD
- Department of Paediatrics, Children's Hospital, Roubaix, France; Paediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
- Manuel J. Rial, MD, PhD
- Allergy department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Gianenrico Senna, MD, PhD
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
- Luciana K. Tanno, MD, PhD
- Hospital Sírio Libanês, São Paulo, Brazil; University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
- Dana V. Wallace, MD
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Margitta Worm, MD, PhD
- Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany
- Mário Morais-Almeida, MD, PhD
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
- Journal volume & issue
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Vol. 17,
no. 3
p. 100876
Abstract
There is a lack of consensus over the description and severity assignment of allergic adverse reactions to immunotherapy, although there seems to be a consensus at least in terms of using the World Allergy Organization (WAO) grading systems to describe local adverse events for Sublingual Immunotherapy (SLIT) and Systemic Allergic Reactions (SARs) to Subcutaneous Immunotherapy (SCIT) amongst the major national/regional allergy societies. In this manuscript, we propose a modification of the previous WAO Grading system for SARs, which aligns with the newly-proposed Consortium for Food Allergy Research (CoFAR) Grading Scale for Systemic Allergic Reactions in Food Allergy (version 3.0). We hope this can facilitate a unified grading system appropriate to SARs due to allergen immunotherapy, independent of allergen and route of administration, and across clinical and research practice.
