Anaphylaxis severity grade, during oral food challenges, assessed by five different classifications

TL;DR

This study compares different severity classifications for anaphylaxis during food challenges, showing significant discrepancies and the need for unified diagnostic criteria.

Contribution

The study evaluates five severity scoring systems for anaphylaxis using ICD-11 as a reference, revealing inconsistencies and advocating for standardized criteria.

Findings

Only 5.6% of patients had complete agreement across all five severity classifications.

Respiratory and gastrointestinal symptoms were more common in anaphylaxis cases.

Adrenaline was administered in less than half of anaphylaxis cases despite being in a specialized setting.

Abstract

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.

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