Description

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).

 


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