Allergy and Clinical Immunology Unit, University Clinic Golnik, Golnik, Slovenia.
Department of Allergy and Clinical Immunology, St James's University Hospital, Leeds, UK.
Int Arch Allergy Immunol. 2024;185(7):694-703. doi: 10.1159/000537680. Epub 2024 Mar 19.
While a consensus seems to have been reached with regard to the definition of anaphylaxis, there is no universal instrument for scoring allergic reaction severity despite more than 30 having been proposed by the time of writing. This severely hampers comparison of data between studies. While scales have been compared with regard to their utility in grading food-related reactions, no such comparisons have been made for Hymenoptera venom-associated reactions.
The study conducted a retrospective analysis to compare the severity of Hymenoptera venom allergy reactions in 104 participants with suspected Hymenoptera venom allergy. The study applied six grading instruments to each reaction, also evaluating them against the NIAID/FAAN anaphylaxis criteria. Sensitivity, specificity, and receiver operating characteristic area under the curve (AUC) for identifying anaphylaxis were calculated. Severity scales were simplified into "mild," "moderate," and "severe" categories. The most common severity grade across the five scales was determined using a custom function to establish a consensus severity grade.
The most common culprit insects were honeybees (49.0%). Among the 88 participants with generalized reactions, the highest proportion had involvement of four organ systems. The scales showed high specificity for detecting anaphylaxis, especially when using higher grades of the Mueller, WAO, and Dribin scales. The diagnostic yields (AUC) varied, with the WAO scale having the highest AUC (0.94) for grades 3, 4, and 5. Spearman correlation analysis showed the strongest correlations seen between the Brown and Dribin, Ring and Messmer and Dribin, and Ring and Messmer and Reisman scales. The lowest correlations were observed with the Mueller scale when paired with the WAO, Reisman, and Dribin scales. An inter-rater reliability analysis showed substantial agreement between scales with the same number of grading levels. The agreement was highest for the Brown and Dribin scales, indicating a strong consistency in reaction severity classification across different instruments.
While all instruments were effective in stratifying reactions, they showed limitations in differentiating milder phenotypes. The Brown and Dribin scales stood out for their high agreement with the consensus score and sensitivity in identifying anaphylaxis. Our findings suggest that adopting either of these scales could significantly unify the reporting of allergic reactions. We believe the format of an instrument should be tailored to its intended purpose, with clinical decision aids being simpler and research tools being more detailed.
尽管对于过敏反应的定义似乎已经达成共识，但尽管到撰写本文时已经提出了 30 多种评分方法，仍然没有通用的过敏反应严重程度评分工具。这严重妨碍了研究之间的数据比较。虽然已经针对食物相关反应的分级量表进行了比较，但对于蜂类毒液相关反应却没有进行过此类比较。
该研究对 104 例疑似蜂类毒液过敏的患者进行了回顾性分析，比较了他们的蜂类毒液过敏反应的严重程度。该研究对每种反应应用了 6 种评分量表，并根据 NIAID/FAAN 过敏反应标准对其进行了评估。计算了识别过敏反应的敏感性、特异性和接收器操作特征曲线（AUC）。将严重程度量表简化为“轻度”、“中度”和“重度”类别。使用自定义函数确定最常见的严重程度等级，以确定五个量表中最常见的严重程度等级。
最常见的罪魁祸首昆虫是蜜蜂（49.0%）。在 88 例有全身反应的参与者中，有四个器官系统受累的比例最高。这些量表对检测过敏反应具有很高的特异性，尤其是当使用 Mueller、WAO 和 Dribin 量表的较高等级时。诊断效果（AUC）各不相同，WAO 量表对等级 3、4 和 5 的 AUC（0.94）最高。Spearman 相关性分析显示，Brown 和 Dribin、Ring 和 Messmer 和 Dribin 以及 Ring 和 Messmer 和 Reisman 量表之间的相关性最强。当与 WAO、Reisman 和 Dribin 量表配对时，与 Mueller 量表的相关性最低。评分者间信度分析显示，具有相同分级水平的量表之间具有显著的一致性。Brown 和 Dribin 量表之间的一致性最高，表明不同仪器对反应严重程度的分类具有很强的一致性。
虽然所有工具都能有效地对反应进行分层，但它们在区分较轻的表型方面存在局限性。Brown 和 Dribin 量表因其与共识评分的高度一致性和识别过敏反应的敏感性而脱颖而出。我们的研究结果表明，采用这些量表中的任何一种都可以显著统一过敏反应的报告。我们认为，仪器的格式应根据其预期用途进行定制，临床决策辅助工具应更简单，研究工具应更详细。
