Cox et al reported the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction grading system for allergic reactions to subcutaneous immunotherapy. The authors are from Nova Southeastern University, the University of South Florida, Hospital Medica Sur and the University of Genoa.
Patient selection: subcutaneous allergen immunotherapy (SCIT)
Symptom/Sign
Organ System
Grade
generalized pruritis, urticaria, flushing, sensation of heat/warmth, non-oral angioedema
skin
1
rhinitis, nasal congestion, throat-clearing or cough arising from the upper airway
upper respiratory
1
conjunctival erythema, pruritis or tearing
conjunctival
1
nausea, metallic taste or headache
other
1
mild to moderate asthma
lower respiratory
2
abdominal cramps, vomiting or diarrhea
gastrointestinal
2
uterine cramps
other
2
severe asthma
lower respiratory
3
angioedema of the upper airway (tongue, uvula, larynx) with or without stridor
upper respiratory
3
respiratory failure
respiratory
4
hypotension
cardiovascular
4
death
5
where:
• Mild or moderate asthma: drop in PEF or FEV1 less than 40%; responds to inhaled bronchodilator.
• Severe ashtma: drop in PEF or FEV1 GTE 40% or does not respond to inhaled bronchodilator.
Final Designation
Criteria
Grade 5
death
Grade 4
one or both of Grade 4 sign/symptom
Grade 3
one or both of Grade 3 sign/symptom
Grade 2
(2 to 4 Grade 1 sign/symptom) OR (one or more Grade 2 sign/symptom)
Grade 1
one Grade 1 sign/symptom
Grade 0
no signs/symptoms
Additional designation for epinephrine administration
Epinephrine
Suffix
not given
z
given <= 5 minutes after symptom onset
a
given 5.1 to 10 minutes after symptom onset
b
given 10.1 to 20 minutes after symptom onset
c
given > 20 minutes after symptom onset
d
Continue Reading
