Anaphylaxis severity grade assessed by five different classifications.
Abstract
Background – While the definition of anaphylaxis is clear, its grade of
severity remains a subject of debate, especially since different
published classifications provide different grading score, and the same
reaction may not receive the same score from different classifications.
The objective of this study was to evaluate the possible discrepancies
in severity scoring system for anaphylaxis in patients with a positive
food challenge (OFC), using the WHO for the 11 th
version of the International Classification of Diseases (ICD-11) as the
main reference. Methods – We conducted a retrospective observational
study at the University Hospital of Montpellier, France, including
patients with a positive OFC, between 2018 and 2022. We classified the
severity of each reaction, as per the ICD-11 classification, but also as
per four other widely used and validated classifications for grading
anaphylaxis severity. Results – 235 patients presented a positive OFC
between January 2018 and December 2022: 143 suffered from anaphylaxis,
according to the ICD-11 classification. 76.2% of them were classified
as grade 2 according to the ICD-11 classification, and 23.8% as grade
3. When comparing the different classifications, a complete concordance
was recorded in 8 patients (5.6%) only. All classifications showed a
good sensitivity (ranging from 99.3 to 100%), but different specificity
(from 67.4 to 93.5%), and discrepancies between them were shown in most
patients. Conclusion – Our work highlights the need to refine the
different scoring systems, to accurately capture anaphylactic reactions
and ensure appropriate management, and, in the end, to adopt a
universal, intuitive, and easy-to-use classification, such as the ICD-11
one.