Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
Allergy Department, Hospital Clinico San Carlos, Madrid, Spain.
Allergy. 2018 Sep;73(9):1792-1800. doi: 10.1111/all.13408. Epub 2018 Jun 17.
The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders' perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.
准确评估和交流急性过敏反应的严重程度对患者、临床医生、研究人员、食品行业以及公共卫生和监管机构都很重要。严重程度对不同的利益相关者有不同的含义，患者和临床医生对特定症状的重要性评价非常不同。已经产生了许多严重程度评分系统，大多数都集中在对有限组过敏原暴露后的反应严重程度上。它们在格式上存在差异，没有一个使用公认的发展方法，也没有一个经过验证。它们广泛的结果格式导致了解释和应用的困难。因此，仍然需要一个针对过敏反应的经过适当开发和验证的严重程度评分系统，该系统适用于各种过敏原触发因素，并满足不同利益相关者群体的需求。我们提出了一种新的方法来开发和验证一种用于急性过敏反应的协调评分系统，该方法基于一种数据驱动的方法，该方法基于临床和患者经验以及其他利益相关者的观点。我们设想了两种格式：（i）一种数字评分，提供从轻度到重度反应的连续体，这些反应具有临床意义，对过敏保健专业人员和研究人员有用，以及（ii）一种基于三级的序数格式，足够简单，可供其他专业人员和患者使用和理解。在各种环境和人群中对新方法的可靠性和有效性进行测试，将允许在临床研究和常规实践中最终实施标准化评分系统。
