The urgent need for a harmonized severity scoring system for acute allergic reactions

Antonella Muraro; Montserrat Fernandez-Rivas; Kirsten Beyer; Victòria Cardona; Andrew Clark; Esben Eller; Jonathan O'B Hourihane; Marek Jutel; Aziz Sheikh; Ioana Agache; Katrina J Allen; Liz Angier; Barbara Ballmer-Weber; Maria Beatrice Bilò; Carsten Bindslev-Jensen; Carlos A Camargo; Antonella Cianferoni; Audrey DunnGalvin; Philippe A Eigenmann; Susanne Halken; Karin Hoffmann-Sommergruber; Susanne Lau; Caroline Nilsson; Lars K. Poulsen; Franziska Rueff; Jonathan Spergel; Gunter Sturm; Frans Timmermans; Maria J Torres; Paul Turner; Ronald van Ree; Magnus Wickman; Margitta Worm; E N Clare Mills; Graham Roberts

doi:10.1111/all.13408

The urgent need for a harmonized severity scoring system for acute allergic reactions

Antonella Muraro, Montserrat Fernandez-Rivas, Kirsten Beyer, Victòria Cardona, Andrew Clark, Esben Eller, Jonathan O'B Hourihane, Marek Jutel, Aziz Sheikh, Ioana Agache, Katrina J Allen, Liz Angier, Barbara Ballmer-Weber, Maria Beatrice Bilò, Carsten Bindslev-Jensen, Carlos A Camargo, Antonella Cianferoni, Audrey DunnGalvin, Philippe A Eigenmann, Susanne HalkenKarin Hoffmann-Sommergruber, Susanne Lau, Caroline Nilsson, Lars K. Poulsen, Franziska Rueff, Jonathan Spergel, Gunter Sturm, Frans Timmermans, Maria J Torres, Paul Turner, Ronald van Ree, Magnus Wickman, Margitta Worm, E N Clare Mills, Graham Roberts

Department of Clinical Medicine

41 Citations (Scopus)

Abstract

The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders’ perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.

Original language	English
Journal	Allergy
Volume	73
Issue number	9
Pages (from-to)	1792-1800
ISSN	0105-4538
DOIs	https://doi.org/10.1111/all.13408
Publication status	Published - Sept 2018

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Muraro, A., Fernandez-Rivas, M., Beyer, K., Cardona, V., Clark, A., Eller, E., Hourihane, J. OB., Jutel, M., Sheikh, A., Agache, I., Allen, K. J., Angier, L., Ballmer-Weber, B., Bilò, M. B., Bindslev-Jensen, C., Camargo, C. A., Cianferoni, A., DunnGalvin, A., Eigenmann, P. A., ... Roberts, G. (2018). The urgent need for a harmonized severity scoring system for acute allergic reactions. Allergy, 73(9), 1792-1800. https://doi.org/10.1111/all.13408

Muraro, A, Fernandez-Rivas, M, Beyer, K, Cardona, V, Clark, A, Eller, E, Hourihane, JOB, Jutel, M, Sheikh, A, Agache, I, Allen, KJ, Angier, L, Ballmer-Weber, B, Bilò, MB, Bindslev-Jensen, C, Camargo, CA, Cianferoni, A, DunnGalvin, A, Eigenmann, PA, Halken, S, Hoffmann-Sommergruber, K, Lau, S, Nilsson, C, Poulsen, LK, Rueff, F, Spergel, J, Sturm, G, Timmermans, F, Torres, MJ, Turner, P, van Ree, R, Wickman, M, Worm, M, Clare Mills, EN & Roberts, G 2018, 'The urgent need for a harmonized severity scoring system for acute allergic reactions', Allergy, vol. 73, no. 9, pp. 1792-1800. https://doi.org/10.1111/all.13408

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abstract = "The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders{\textquoteright} perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.",

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AU - Clark, Andrew

AU - Eller, Esben

AU - Hourihane, Jonathan O'B

AU - Jutel, Marek

AU - Sheikh, Aziz

AU - Agache, Ioana

AU - Allen, Katrina J

AU - Angier, Liz

AU - Ballmer-Weber, Barbara

AU - Bilò, Maria Beatrice

AU - Bindslev-Jensen, Carsten

AU - Camargo, Carlos A

AU - Cianferoni, Antonella

AU - DunnGalvin, Audrey

AU - Eigenmann, Philippe A

AU - Halken, Susanne

AU - Hoffmann-Sommergruber, Karin

AU - Lau, Susanne

AU - Nilsson, Caroline

AU - Poulsen, Lars K.

AU - Rueff, Franziska

AU - Spergel, Jonathan

AU - Sturm, Gunter

AU - Timmermans, Frans

AU - Torres, Maria J

AU - Turner, Paul

AU - van Ree, Ronald

AU - Wickman, Magnus

AU - Worm, Margitta

AU - Clare Mills, E N

AU - Roberts, Graham

N1 - This article also appears in: JM Must Read Articles - Allergy

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N2 - The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders’ perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.

AB - The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders’ perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.

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DO - 10.1111/all.13408

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VL - 73

SP - 1792

EP - 1800

JO - Allergy

JF - Allergy

IS - 9

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The urgent need for a harmonized severity scoring system for acute allergic reactions

Abstract

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