Bouderbala Yanis, Clark Evangéline, Tanno Luciana Kase, Demoly Pascal, Caimmi Davide
Allergy Unit, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.
Allergy Unit, Hospital of Mont de Marsan, Mont-de-Marsan, France.
Pediatr Allergy Immunol. 2025 Mar;36(3):e70065. doi: 10.1111/pai.70065.
While the definition of anaphylaxis is clear, its grade of severity remains a subject of debate. The objective of this study was to evaluate the possible discrepancies in the severity scoring system for anaphylaxis in patients with a positive food challenge (OFC), differentiating anaphylactic and non-anaphylactic reactions, using the WHO for the 11th version of the International Classification of Diseases (ICD-11) as the main reference.
We conducted a retrospective observational study at the University Hospital of Montpellier, France, including patients with a positive food OFC between 2018 and 2022. We classified the severity of each reaction based on 5 different classifications. We also compared patients presenting an anaphylactic versus a non-anaphylactic reaction during the OFC in terms of symptoms and therapeutic approach.
235 patients presented a positive OFC between January 2018 and December 2022: 143 (60.9%) suffered from anaphylaxis, according to the ICD-11 classification. When comparing the different classifications, a complete concordance was recorded in 8 patients (5.6%) only. All classifications showed a good sensitivity (99.3%-100%), but different specificity (67.4%-93.5%), and discrepancies between them were shown in most patients. Respiratory and gastrointestinal symptoms were significantly more frequent in the anaphylaxis group. Adrenaline was injected in only 47.6% of patients suffering from anaphylaxis, even in a specialized setting.
Our work highlights the need to refine the different scoring systems and, even better, to disseminate unified diagnostic criteria, such as the ICD-11 ones, to avoid the underdiagnosis of anaphylactic reactions and ensure appropriate management for all allergic patients.
虽然过敏反应的定义明确，但其严重程度等级仍是一个有争议的话题。本研究的目的是评估食物激发试验（OFC）阳性患者中过敏反应严重程度评分系统可能存在的差异，以世界卫生组织第11版《国际疾病分类》（ICD - 11）为主要参考，区分过敏反应和非过敏反应。
我们在法国蒙彼利埃大学医院进行了一项回顾性观察研究，纳入2018年至2022年间食物OFC阳性的患者。我们根据5种不同分类对每种反应的严重程度进行分类。我们还比较了在OFC期间出现过敏反应与非过敏反应的患者在症状和治疗方法方面的情况。
2018年1月至2022年12月期间，235例患者食物OFC呈阳性：根据ICD - 11分类，143例（60.9%）发生过敏反应。比较不同分类时，仅8例患者（5.6%）完全一致。所有分类均显示出良好的敏感性（99.3% - 100%），但特异性不同（67.4% - 93.5%），且大多数患者中各分类之间存在差异。过敏反应组的呼吸道和胃肠道症状明显更常见。即使在专科环境中，仅有47.6%的过敏反应患者注射了肾上腺素。
我们的研究强调需要完善不同的评分系统，甚至更好地推广统一的诊断标准，如ICD - 11的标准，以避免过敏反应的漏诊，并确保对所有过敏患者进行适当管理。
