Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

P. M. Hopkins; P. J. Cooke; R. C. Clarke; A. B. Guttormsen; P. R. Platt; P. Dewachter; D. G. Ebo; T. Garcez; L. H. Garvey; D. L. Hepner; D. A. Khan; H. Kolawole; P. Kopac; M. Krøigaard; J. J. Laguna; S. D. Marshall; P. M. Mertes; M. A. Rose; V. Sabato; L. C. Savic; S. Savic; T. Takazawa; G. W. Volcheck; S. Voltolini; P. H.M. Sadleir

doi:10.1016/j.bja.2019.02.029

Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

P. M. Hopkins^*, P. J. Cooke, R. C. Clarke, A. B. Guttormsen, P. R. Platt, P. Dewachter, D. G. Ebo, T. Garcez, L. H. Garvey, D. L. Hepner, D. A. Khan, H. Kolawole, P. Kopac, M. Krøigaard, J. J. Laguna, S. D. Marshall, P. M. Mertes, M. A. Rose, V. Sabato, L. C. SavicS. Savic, T. Takazawa, G. W. Volcheck, S. Voltolini, P. H.M. Sadleir

^*Corresponding author for this work

Department of Clinical Medicine

17 Citations (Scopus)

Abstract

Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1–9)and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more)and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.

Original language	English
Journal	British Journal of Anaesthesia
Volume	123
Issue number	1
Pages (from-to)	e29-e37
ISSN	0007-0912
DOIs	https://doi.org/10.1016/j.bja.2019.02.029
Publication status	Published - 2019

Keywords

allergy
anaesthesia
anaphylaxis
drug hypersensitivity
perioperative period
surgery

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10.1016/j.bja.2019.02.029

http://bjanaesthesia.org/article/S0007091219301916/pdf

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Hopkins, P. M., Cooke, P. J., Clarke, R. C., Guttormsen, A. B., Platt, P. R., Dewachter, P., Ebo, D. G., Garcez, T., Garvey, L. H., Hepner, D. L., Khan, D. A., Kolawole, H., Kopac, P., Krøigaard, M., Laguna, J. J., Marshall, S. D., Mertes, P. M., Rose, M. A., Sabato, V., ... Sadleir, P. H. M. (2019). Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions. British Journal of Anaesthesia, 123(1), e29-e37. https://doi.org/10.1016/j.bja.2019.02.029

Hopkins, PM, Cooke, PJ, Clarke, RC, Guttormsen, AB, Platt, PR, Dewachter, P, Ebo, DG, Garcez, T, Garvey, LH, Hepner, DL, Khan, DA, Kolawole, H, Kopac, P, Krøigaard, M, Laguna, JJ, Marshall, SD, Mertes, PM, Rose, MA, Sabato, V, Savic, LC, Savic, S, Takazawa, T, Volcheck, GW, Voltolini, S & Sadleir, PHM 2019, 'Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions', British Journal of Anaesthesia, vol. 123, no. 1, pp. e29-e37. https://doi.org/10.1016/j.bja.2019.02.029

@article{af2784a0f65a4b3c9fb576a0298805b2,

title = "Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions",

abstract = "Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1–9)and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more)and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.",

keywords = "allergy, anaesthesia, anaphylaxis, drug hypersensitivity, perioperative period, surgery",

author = "Hopkins, {P. M.} and Cooke, {P. J.} and Clarke, {R. C.} and Guttormsen, {A. B.} and Platt, {P. R.} and P. Dewachter and Ebo, {D. G.} and T. Garcez and Garvey, {L. H.} and Hepner, {D. L.} and Khan, {D. A.} and H. Kolawole and P. Kopac and M. Kr{\o}igaard and Laguna, {J. J.} and Marshall, {S. D.} and Mertes, {P. M.} and Rose, {M. A.} and V. Sabato and Savic, {L. C.} and S. Savic and T. Takazawa and Volcheck, {G. W.} and S. Voltolini and Sadleir, {P. H.M.}",

year = "2019",

doi = "10.1016/j.bja.2019.02.029",

language = "English",

volume = "123",

pages = "e29--e37",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

number = "1",

}

TY - JOUR

T1 - Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

AU - Hopkins, P. M.

AU - Cooke, P. J.

AU - Clarke, R. C.

AU - Guttormsen, A. B.

AU - Platt, P. R.

AU - Dewachter, P.

AU - Ebo, D. G.

AU - Garcez, T.

AU - Garvey, L. H.

AU - Hepner, D. L.

AU - Khan, D. A.

AU - Kolawole, H.

AU - Kopac, P.

AU - Krøigaard, M.

AU - Laguna, J. J.

AU - Marshall, S. D.

AU - Mertes, P. M.

AU - Rose, M. A.

AU - Sabato, V.

AU - Savic, L. C.

AU - Savic, S.

AU - Takazawa, T.

AU - Volcheck, G. W.

AU - Voltolini, S.

AU - Sadleir, P. H.M.

PY - 2019

Y1 - 2019

N2 - Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1–9)and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more)and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.

AB - Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1–9)and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more)and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.

KW - allergy

KW - anaesthesia

KW - anaphylaxis

KW - drug hypersensitivity

KW - perioperative period

KW - surgery

U2 - 10.1016/j.bja.2019.02.029

DO - 10.1016/j.bja.2019.02.029

M3 - Journal article

C2 - 31029409

AN - SCOPUS:85064565700

SN - 0007-0912

VL - 123

SP - e29-e37

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 1

ER -

Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

Abstract

Keywords

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