Introduction
Anaphylaxis is the most severe immediate hypersensitivity reaction, which may potentially result in the death1. In 2013, Panesar reported an incidence of anaphylaxis between 1.5 and 7.9 per million inhabitants per year2. Although the number of deaths due to anaphylaxis remains low, the frequency of anaphylactic cases and of cases at-risk of anaphylaxis has been increasing in recent years3.
The clinical definition of anaphylaxis remains the involvement of at least 2 organs (cutaneous signs, respiratory symptoms, digestive symptoms), as initially described by Ring and Messmer in 19774, and later adapted by other publications, including the one from the World Health Organization (WHO) for the International Classification of Diseases (ICD)-115. A recent definition is that anaphylaxis is a serious allergic reaction that occurs rapidly and can result in death6. As for the classification of the severity of an anaphylactic reaction, such topic remains a matter of debate. In recent years, several classifications emerged, enriching the existing ones, such as those from the ICD-117, the CoFAR one8, or those by Sampson9, Muraro10, and Blazowski11, and provided different scores to grade the severity of an allergic anaphylactic reaction.
These different classifications allowed a major advancement in the management of anaphylaxis (guiding the early use of adrenaline), however, differences between them perpetuate a lack of uniformity in grading different levels of severity, and consequently, potential differences in the therapeutic approach to patients experiencing the reaction. In clinical practice, the proliferation of classifications led to a lack of reproducibility, as the same reaction may not receive the same score from different classifications, which may then impact both the timing and the choice of a specific treatment.
The objective of this study was to evaluate the possible discrepancies in severity scoring system for anaphylaxis by applying them in patients who presented a positive food challenge, in the Allergy Unit of a University Hospital, using the WHO for the 11thversion of the International Classification of Diseases (ICD-11) as the main reference.