National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Hospital Clínic de Barcelona, Barcelona, Spain.
J Allergy Clin Immunol Pract. 2021 Nov;9(11):4075-4086.e5. doi: 10.1016/j.jaip.2021.06.056. Epub 2021 Jul 19.
There is no current consensus on assigning severity to food-induced allergic reactions, for example, to assess the efficacy of allergen immunotherapy. Existing severity scores lack the capability to discriminate between non-anaphylaxis reactions of different severities. Attempts are ongoing to develop a more discriminatory score, which should ideally be data-driven and validated in multiple cohorts.
To undertake an exercise using best-worst scaling (BWS) to define a potential gold standard against which severity scoring of food-induced allergic reactions can be refined.
We undertook a global survey to better understand how health care professionals rate the severity of food-induced allergic reactions, using BWS methodology. Respondents were given a number of patient case vignettes describing real-world allergic reactions and asked to select the pair that, in their opinion, reflected the maximum difference in severity. Responses were then modeled and a preference score (representing severity) determined for each scenario. Scenarios were also scored using existing published scoring systems and the scores compared with the BWS score using Spearman r correlation and Cohen kappa. Given the differences in definitions of anaphylaxis globally, we also evaluated differences in BWS ranking depending on the geographical location of respondents.
We received 334 complete responses, 183 (55%) from Europe and 65 (20%) from North America. Perception of severity of some reactions appeared to be affected by geographical location. The comparison of BWS ranking with current grading systems identified significant issues that varied from one grading system to another, such as prominence to some symptoms (eg, vomiting) that skew grading when using scoring systems not designed for food allergy. In general, current scoring systems poorly discriminate against more mild symptoms and often overestimate their severity.
These data provide a methodology free of user scale bias to help define a potential, consensus-driven gold standard that can be used to guide and validate the development of improved grading systems to score food-induced allergic symptoms and highlight areas for education where there is the potential to miscategorize severity.
目前对于食物诱发过敏反应的严重程度尚未达成共识，例如评估过敏原免疫疗法的疗效。现有的严重程度评分缺乏区分不同严重程度的非过敏反应的能力。目前正在尝试开发一种更具区分度的评分方法，该方法理想情况下应基于数据，并在多个队列中得到验证。
采用最佳最差量表（BWS）开展一项研究，旨在定义一个潜在的黄金标准，以对食物诱发过敏反应的严重程度评分进行优化。
我们采用 BWS 方法开展了一项全球调查，以更好地了解医疗保健专业人员如何评估食物诱发过敏反应的严重程度。受访者需对一系列描述现实世界过敏反应的患者病例描述进行选择，选择他们认为反映最大严重程度差异的一对。然后对这些回答进行建模，并确定每个病例的偏好评分（代表严重程度）。还使用现有的已发表评分系统对病例进行评分，并使用 Spearman r 相关系数和 Cohen kappa 比较 BWS 评分与各评分系统的相关性。鉴于全球对过敏反应的定义存在差异，我们还评估了受访者地理位置对 BWS 排名的影响。
我们共收到 334 份完整回复，其中 183 份（55%）来自欧洲，65 份（20%）来自北美。一些反应严重程度的感知似乎受到地理位置的影响。BWS 排名与当前分级系统的比较显示出一些显著的问题，这些问题因分级系统而异，例如某些症状（如呕吐）的突出程度，这些症状会因使用并非专为食物过敏设计的评分系统而导致分级结果产生偏差。总体而言，目前的评分系统对更轻微的症状区分度较差，且往往高估了其严重程度。
这些数据提供了一种无用户量表偏倚的方法，有助于定义一个潜在的、基于共识的黄金标准，可用于指导和验证改善食物诱发过敏症状评分的分级系统的开发，并突出可能导致严重程度分类错误的教育领域。
