Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee

Paul J Turner; Ignacio J Ansotegui; Dianne E Campbell; Victoria Cardona; Stuart Carr; Adnan Custovic; Stephen Durham; Motohiro Ebisawa; Mario Geller; Alexei Gonzalez-Estrada; Paul A Greenberger; Elham Hossny; Carla Irani; Agnes S Y Leung; Michael E Levin; Antonella Muraro; John J Oppenheimer; José Antonio Ortega Martell; Guillaume Pouessel; Manuel J Rial; Gianenrico Senna; Luciana K Tanno; Dana V Wallace; Margitta Worm; Mário Morais-Almeida; WAO Anaphylaxis Committee and WAO Allergen Immunotherapy Committee

doi:10.1016/j.waojou.2024.100876

Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee

World Allergy Organ J. 2024 Feb 10;17(3):100876. doi: 10.1016/j.waojou.2024.100876. eCollection 2024 Mar.

Authors

Paul J Turner¹, Ignacio J Ansotegui², Dianne E Campbell^{3

4}, Victoria Cardona⁵, Stuart Carr⁶, Adnan Custovic¹, Stephen Durham¹, Motohiro Ebisawa⁷, Mario Geller⁸, Alexei Gonzalez-Estrada⁹, Paul A Greenberger¹⁰, Elham Hossny¹¹, Carla Irani¹², Agnes S Y Leung¹³, Michael E Levin¹⁴, Antonella Muraro¹⁵, John J Oppenheimer¹⁶, José Antonio Ortega Martell¹⁷, Guillaume Pouessel^{18

19}, Manuel J Rial²⁰, Gianenrico Senna²¹, Luciana K Tanno^{22

23}, Dana V Wallace²⁴, Margitta Worm²⁵, Mário Morais-Almeida²⁶; WAO Anaphylaxis Committee and WAO Allergen Immunotherapy Committee

Affiliations

¹ National Heart Lung Institute, Imperial College London, London, UK.
² Dept. Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
³ Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
⁴ DBV Technologies, Montrouge, France.
⁵ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
⁶ Snö Asthma & Allergy, Abu Dhabi, United Arab Emirates.
⁷ Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
⁸ Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil.
⁹ Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
¹⁰ Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹¹ Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹² Hotel Dieu de France Hospital, St Joseph University, Beirut, Lebanon.
¹³ Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
¹⁴ Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa.
¹⁵ Department of Woman and Child Health, Food Allergy Referral Centre, Padua University Hospital, Padua, Italy.
¹⁶ Rutgers New Jersey Medical School, Atlantic Health System Morristown, NJ, USA.
¹⁷ Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico.
¹⁸ Department of Paediatrics, Children's Hospital, Roubaix, France.
¹⁹ Paediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, Lille, France.
²⁰ Allergy department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
²¹ Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.
²² Hospital Sírio Libanês, São Paulo, Brazil.
²³ University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France.
²⁴ Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, FL, USA.
²⁵ Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany.
²⁶ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.

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.

Keywords: Adverse events; Allergen immunotherapy; Anaphylaxis; Clinical trials; Safety reporting.

Publication types

Review