Ring and Messmer graded anaphylactoid reactions based on clinical 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).
Specialty: Immunology/Rheumatology
ICD-10: ,