World Allergy Organization Journal (Mar 2023)
WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)
- Stefania Arasi, MD, PhD, MSc,
- Ulugbek Nurmatov, MD,
- Audrey Dunn-Galvin, PhD,
- Graham Roberts, DM,
- Paul J. Turner, FRCPCH, PhD,
- Sayantani B. Shinder, MD, PhD,
- Ruchi Gupta, MD, MPh,
- Philippe Eigenmann, MD,
- Anna Nowak-Wegrzyn, MD, PhD,
- Ignacio J. Ansotegui, MD, PhD,
- Montserrat Fernandez Rivas, MD,
- Stavros Petrou, PhD,
- Luciana K. Tanno, MD, PhD,
- Marta Vazquez-Ortiz, MD, PhD,
- Brian Vickery, MD, PhD,
- Gary Wong, MD, FRCPC,
- Montserrat Alvaro-Lozano, MD, PhD,
- Miqdad Asaria, PhD,
- Philippe Begin, MD, MSc,
- Martin Bozzola, MD,
- Robert Boyle, MD,
- Helen Brough, MD, PhD,
- Victoria Cardona, MD, PhD,
- R. Sharon Chinthrajah, MD, PhD,
- Antonella Cianferoni, MD,
- Antoine Deschildre, MD,
- David Fleischer, MD,
- Flavio Gazzani, PhD,
- Jennifer Gerdts,
- Marilena Giannetti, PhD,
- Matthew Greenhawt, MD, MBA, MSc,
- Maria Antonieta Guzmán, MD,
- Elham Hossny, MD, PhD, FAAAAI,
- Paula Kauppi, MD,
- Carla Jones,
- Francesco Lucidi, PhD,
- Olga Patricia Monge Ortega, MD, PhD,
- Daniel Munblit, MD, PhD,
- Antonella Muraro, MD,
- Giovanni Pajno, MD,
- Marcia Podestà,
- Pablo Rodriguez del Rio, MD, PhD,
- Maria Said,
- Alexandra Santos, MD, MSc, MRCPCH, PGCAP, FHEA, PhD,
- Marcus Shaker, MD,
- Hania Szajewska, MD, PhD,
- Carina Venter, PhD,
- Cristopher Warren, PhD,
- Tonya Winders,
- Motohiro Ebisawa, MD, PhD,
- Alessandro Fiocchi, MD
Affiliations
- Stefania Arasi, MD, PhD, MSc
- Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Corresponding author. Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Piazza S. Onofrio, 00161 Rome, Italy.
- Ulugbek Nurmatov, MD
- Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
- Audrey Dunn-Galvin, PhD
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
- Graham Roberts, DM
- Faculty of Medicine, University of Southampton, Southampton, UK; The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Paul J. Turner, FRCPCH, PhD
- National Heart & Lung Institute, Imperial College London, London, UK
- Sayantani B. Shinder, MD, PhD
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA; Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
- Ruchi Gupta, MD, MPh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Philippe Eigenmann, MD
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
- Anna Nowak-Wegrzyn, MD, PhD
- Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
- Ignacio J. Ansotegui, MD, PhD
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Montserrat Fernandez Rivas, MD
- Allergy Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
- Stavros Petrou, PhD
- Nuffield Department of Primary Care Health Sciences, University of Oxford; Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK; Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, England, UK
- Luciana K. Tanno, MD, PhD
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, France; Desbrest Institute of Epidemiology and Public Health, UA-11, INSERM University of Montpellier, France; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
- Marta Vazquez-Ortiz, MD, PhD
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Brian Vickery, MD, PhD
- Department of Pediatrics, Emory University, Atlanta, GA, USA
- Gary Wong, MD, FRCPC
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- Montserrat Alvaro-Lozano, MD, PhD
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; Universitat de Barcelona, Spain
- Miqdad Asaria, PhD
- Department of Health Policy, London School of Economics and Political Science, UK
- Philippe Begin, MD, MSc
- Allergy, immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada; Allergy and Clinical immunology Division, Department of Medicine, Centre Hospitalier de l’Université de Montréal, QC, Canada
- Martin Bozzola, MD
- Hospital Britanico de Buenos Aires Buenos Aires, Argentina
- Robert Boyle, MD
- National Heart and Lung Institute, Imperial College London, UK
- Helen Brough, MD, PhD
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK; Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Victoria Cardona, MD, PhD
- Allergy Section, Department of Internal Medicine, Hospital Vall D’Hebron, Barcelona, Spain; ARADyAL Research Network, Spain
- R. Sharon Chinthrajah, MD, PhD
- Sean N Parker Center for Allergy and Asthma Research, Stanford University
- Antonella Cianferoni, MD
- The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA, United States
- Antoine Deschildre, MD
- CHU Lille, Univ Lille, Pediatric Allergy and Pulmonology Unit, Hôpital Jeanne de Flandre, 59000 Lille, France; Section of Pediatric Allergy & Immunology, Children's Hospital Colorado, USA
- David Fleischer, MD
- University of Colorado School of Medicine, USA
- Flavio Gazzani, PhD
- Departement of Economics and Law, University of Rome La Sapienza, Italy
- Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
- Marilena Giannetti, PhD
- Departement of Economics and Law, University of Rome La Sapienza, Italy
- Matthew Greenhawt, MD, MBA, MSc
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Maria Antonieta Guzmán, MD
- Immunology and Allergy Service, Clinical Hospital University of Chile, Santiago, Chile
- Elham Hossny, MD, PhD, FAAAAI
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
- Paula Kauppi, MD
- University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Carla Jones
- Chief Executive of Patient Organisation, Allergy UK, London, UK
- Francesco Lucidi, PhD
- Allergology Unit of the San Juan de Dios Hospital, San José, Costa Rica
- Olga Patricia Monge Ortega, MD, PhD
- Departement of Economics and Law, University of Rome La Sapienza, Italy
- Daniel Munblit, MD, PhD
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom; Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Antonella Muraro, MD
- Food Allergy Centre Department of Woman and Child Health Padua University Hospital, Padua Italy
- Giovanni Pajno, MD
- Pediatric Unit- Policlinico Hospital, University of Messina, Messina, Italy
- Marcia Podestà
- Food Allergy Italia, Italy
- Pablo Rodriguez del Rio, MD, PhD
- Hospital Universitario Infantil Niño Jesus, Madrid, Spain
- Maria Said
- CEO Allergy & Anaphylaxis Australia, Sydney, Australia
- Alexandra Santos, MD, MSc, MRCPCH, PGCAP, FHEA, PhD
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Marcus Shaker, MD
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Dartmouth Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon
- Hania Szajewska, MD, PhD
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
- Carina Venter, PhD
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
- Cristopher Warren, PhD
- Center for Food Allergy and Asthma Research, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA
- Tonya Winders
- Allergy & Asthma Network (AAN), President and CEO, Allergy and Asthma Network, Vienna, VA, USA
- Motohiro Ebisawa, MD, PhD
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara Japan
- Alessandro Fiocchi, MD
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Journal volume & issue
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Vol. 16,
no. 3
p. 100753
Abstract
Background: While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole. Aim: To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring system, to be used globally. Methods: Phase 1: We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts. Phase 2: Based on our findings in Phase 1, we drafted statements for a two-round modified electronic Delphi (e-Delphi) survey. A purposefully selected multidisciplinary international expert panel on food allergy (n = 60) was identified and sent a structured questionnaire, including a set of statements on different domains of food allergy severity related to symptoms, health-related quality of life, and economic impact. Participants were asked to score their agreement on each statement on a 5-point Likert scale ranging from “strongly agree” to “strongly disagree”. Median scores and percentage agreements were calculated. Consensus was defined a priori as being achieved if 70% or more of panel members rated a statement as “strongly agree” to “agree” after the second round. Based on feedback, 2 additional online voting rounds were conducted. Results: We received responses from 92% of Delphi panel members in round 1 and 85% in round 2. Consensus was achieved on the overall score and in all of the 5 specific key domains as essential components of the DEFASE score. Conclusions: The DEFASE score is the first comprehensive grading of food allergy severity that considers not only the severity of a single reaction, but the whole disease spectrum. An international consensus has been achieved regarding a scoring system for food allergy disease. It offers an evaluation grid, which may help to rate the severity of food allergy. Phase 3 will involve validating the scoring system in research settings, and implementing it in clinical practice.
