Grading Scheme of Ring and Messmer for Anaphylactic Symptoms

 

Symptom groups:

(1) dermal

(2) abdominal (gastrointestinal)

(3) respiratory

(4) cardiovascular

 

Grades: 1 (mild) to 4 (severe)

 

Dermal reactions can be seen in all 4 grades and consisted of:

(1) pruritus

(2) flushing

(3) urticaria

(4) angioedema

 

The appearance of abdominal, respiratory and/or cardiovascular findings indicates Grade 2 to 4.

 

Grade 4 is indicated by respiratory and/or cardiac arrest.

Symptom Group	Grade 2	Grade 3
abdominal	nausea or cramping	vomiting or diarrhea
respiratory	rhinorrhea, dyspnea, hoarseness	laryngeal edema, cyanosis, bronchospasm
cardiovascular	tachycardia, change in blood pressure, cardiac arrhythmias	shock

 

where:

• The dermal symptoms do not appear to be graded by intensity.

• Tachycardia was defined as an increase in pulse by > 20 beats per minute.

• A change in blood pressure is a change in systolic blood pressure > 20 mm Hg (this would be a drop in most patients).