From: Sublingual immunotherapy: World Allergy Organization position paper 2013 update
Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
---|---|---|---|---|
Symptoms(s)/sign(s) of one organ system present:* | Symptoms(s)/sign(s) of more than one organ system present: | Lower respiratory | Lower or upper respiratory | Death |
Asthma (eg, 40% PEF or FEV1 drop, NOT responding to an inhaled bronchodilator) | Respiratory failure with or without loss of consciousness | |||
Cutaneous | ||||
Generalized pruritis, urticaria, flushing, or sensation of heat or warmth** | ||||
or | or | or | or | |
Angioedema (not laryngeal, tongue, or uvular) | Lower respiratory | Upper respiratory | Cardiovascular | |
or | Asthma: cough, wheezing, shortness of breath (eg, <40% PEF or FEV1 drop, responding to an inhaled bronchodilator) | Laryngeal, uvula, or tongue edema with or without stridor | Hypotension with or without loss of consciousness | |
Upper respiratory | ||||
Rhinitis (eg, sneezing, rhinorrhea, nasal pruritis, and/or nasal congestion) | ||||
or | or | |||
Throat-clearing (itchy throat) | ||||
or | Gastrointestinal | |||
Cough perceived to come from the upper airway, not the lung, larynx, or trachea | Abdominal cramps, vomiting, or diarrhea | |||
or | or | |||
Conjunctival | ||||
Conjunctival erythema, pruritus, or tearing | Other | |||
Uterine cramps | ||||
Other | ||||
Nausea, metallic taste, or headache | ||||
Patients may also have a feeling of impending doom, especially in grades 2, 3, or 4. | ||||
Note: children with anaphylaxis seldom convey a sense of impending doom and their behavior changes may be a sign of anaphylaxis, eg, becoming very quiet or irritable and cranky. | ||||
Scoring includes a suffix that denotes if and when epinephrine is administered in relationship to symptom(s)/sign(s) of the SR: a, ≤5 minutes; b, >5 minutes to ≤10 minutes; c, >10 to ≤20 minutes; d, >20 minutes; z, epinephrine not administered. | ||||
The final grade of the reaction will not be determined until the event is over, regardless of the medication administered. The final report should include the first symptom(s)/sign(s) and the time of onset after the subcutaneous allergen immunotherapy injection† and a suffix reflecting if and when epinephrine was administered, eg, Grade 2a; rhinitis: 10 minutes. | ||||
Final report: Grade, a-d or z ________________First symptom ________________ Time of onset of first symptom ________________ | ||||
Comments †† |