Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex.
Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
J Allergy Clin Immunol. 2023 Dec;152(6):1581-1586. doi: 10.1016/j.jaci.2023.08.018. Epub 2023 Aug 29.
There is no accepted grading system classifying the severity of immediate reactions to drugs.
The purpose of this article is to present a proposed grading system developed through the consensus of drug allergy experts from the United States Drug Allergy Registry (USDAR) Consortium.
The USDAR investigators sought to develop a consensus severity grading system for immediate drug reactions that is applicable to clinical care and research.
The USDAR grading scale scores severity levels on a scale of 0 to 4. A grade of no reaction (NR) is used for patients who undergo challenge without any symptoms or signs, and it would confirm a negative challenge result. A grade 0 reaction is indicative of primarily subjective complaints that are commonly seen with both historical drug reactions and during drug challenges, and it would suggest a low likelihood of a true drug allergic reaction. Grades 1 to 4 meet the criteria for a positive challenge result and may be considered indicative of a drug allergy. Grade 1 reactions are suggestive of a potential immediate drug reaction with mild symptoms. Grade 2 reactions are more likely to be immediate drug reactions of moderate severity. Grade 3 reactions have features suggestive of a severe allergic reaction, whereas grade 4 reactions are life-threatening reactions such as anaphylactic shock and fatal anaphylaxis.
This proposed grading schema for immediate drug reactions improves on prior schemata by being developed specifically for immediate drug reactions and being easy to implement in clinical and research practice.
目前尚无被广泛接受的药物过敏即时反应严重程度分级系统。
本文旨在介绍一种通过美国药物过敏注册中心（USDAR）专家共识制定的新的即时药物过敏反应严重程度分级系统。
USDAR 研究人员旨在开发一种适用于临床和研究的即时药物过敏反应严重程度分级系统。
USDAR 分级量表的严重程度评分为 0-4 级。无反应（NR）等级用于接受挑战但无任何症状或体征的患者，这将确认阴性挑战结果。0 级反应表示主要是主观抱怨，在药物过敏反应和药物挑战中均常见，这表明发生真正药物过敏反应的可能性较低。1-4 级符合阳性挑战结果的标准，可能被认为提示药物过敏。1 级反应提示有潜在的即时药物过敏反应，症状轻微。2 级反应更可能是中度严重的即时药物过敏反应。3 级反应具有严重过敏反应的特征，而 4 级反应则是危及生命的过敏反应，如过敏性休克和致命性过敏性休克。
该即时药物过敏反应分级方案优于既往方案，因为它是专为即时药物过敏反应而制定的，且易于在临床和研究实践中实施。
