Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York.
J Allergy Clin Immunol. 2020 Nov;146(5):1089-1096. doi: 10.1016/j.jaci.2020.08.015. Epub 2020 Aug 24.
The use of inconsistent definitions for anaphylaxis outcomes limits our understanding of the natural history and epidemiology of anaphylaxis, hindering clinical practice and research efforts.
Our aim was to develop consensus definitions for clinically relevant anaphylaxis outcomes by utilizing a multidisciplinary group of clinical and research experts in anaphylaxis.
Using Delphi methodology, we developed agenda topics and drafted questions to review during monthly conference calls. Through online surveys, a 19-member panel consisting of experts in allergy and/or immunology and emergency medicine rated their level of agreement with the appropriateness of statements on a scale of 1 to 9. A median value of 1.0 to 3.4 was considered inappropriate, a median value of 3.5 to 6.9 was considered uncertain, and a median value of 7.0 to 9.0 was considered appropriate. A disagreement index was then calculated, with values less than 1.0 categorized as "consensus reached." If consensus was not reached after the initial survey, subsequent surveys incorporating the aggregate de-identified responses from prior surveys were sent to panel members. This process was repeated until consensus was reached or 4 survey rounds had been completed, after which the question was categorized as "no consensus reached."
The panel developed outcome definitions for persistent, refractory, and biphasic anaphylaxis, as well as for persistent and biphasic nonanaphylactic reactions. There was also consensus among panel members regarding the need to develop an anaphylaxis severity grading system.
Dissemination and application of these definitions in clinical care and research will help standardize the terminology used to describe anaphylaxis outcomes and serve as the foundation for future research, including research aimed at development of an anaphylaxis severity grading system.
由于对过敏反应结局的定义不一致，限制了我们对过敏反应自然史和流行病学的理解，从而影响了临床实践和研究工作。
本研究旨在通过使用过敏反应领域的多学科临床和研究专家，为具有临床意义的过敏反应结局制定共识定义。
使用德尔菲法，我们制定了议程主题，并起草了问题，以便在每月的电话会议上进行审查。通过在线调查，由过敏和/或免疫学以及急诊医学专家组成的 19 人小组对各项陈述的适宜性进行了 1 到 9 分的评分。评分 1.0 到 3.4 分被认为是不适当的，评分 3.5 到 6.9 分被认为是不确定的，评分 7.0 到 9.0 分被认为是适当的。然后计算了分歧指数，小于 1.0 的值被归类为“达成共识”。如果在初始调查后没有达成共识，则会向小组成员发送包含之前调查汇总匿名回复的后续调查。如果仍然没有达成共识，将进行 4 轮调查，然后将该问题归类为“未达成共识”。
小组为持续性、难治性和双相性过敏反应以及持续性和双相性非过敏反应制定了结局定义。小组成员还就需要制定过敏反应严重程度分级系统达成了共识。
这些定义在临床护理和研究中的传播和应用将有助于标准化用于描述过敏反应结局的术语，并为未来的研究奠定基础，包括旨在开发过敏反应严重程度分级系统的研究。
