Use of the Severity Grading System for Acute Allergic Reactions (SGS-AR) to Evaluate Allergic Reactions During Peanut Oral Food Challenges in a Pediatric Allergy Center
H. Richard Droghini, MD; Amal Assa’ad, MD; Justin Schwartz, MD, PhD; Kimberly Risma, MD, PhD
There is no validated grading scale to standardize the severity of allergic reactions. This project is a retrospective application of a new grading scale with goals of validating it for use in the oral food challenge setting and standardizing post reaction monitoring and care.
H. Richard Droghini, MD
Abstract
Background: There exists no standardized and validated grading system for allergic reactions. We utilized a newly devised severity grading system for acute allergic reactions (SGS-AR) to assess clinical responses during oral food challenges (OFC). The SGS-AR was developed by allergists and emergency physicians via Delphi consensus methodology. It requires validation in a variety of clinical settings, and the highly granular data collected during OFC allergic reactions lends itself to scoring.
Objective: We hypothesized that patients who required epinephrine would have higher SGS-AR grades, and higher SGS-AR grades would be associated with more extensive post-reaction monitoring.
Methods: A non-allergist (pediatric resident) reviewed the prospectively collected allergic signs and symptoms to calculate the SGS-AR grade (scale 1-5; 5 being most severe) occurring in sixty-six children (age 6mo – 17yrs) who received epinephrine during peanut OFCs. For comparison, allergic reactions were graded in a “control” group of age, sex, and race matched children undergoing peanut OFC without requiring epinephrine.
Results: The epinephrine group experienced grade 4 (7%), grade 3 (32%), and grade 2 (61%) reactions. The control group experienced grade 3 (3%), grade 2 (53%), and grade 1 (44%) reactions. Higher SGS-AR grade correlated with increased post-epinephrine monitoring time, although highly variable in grade 2 and 3 reactions. Patients suffering grade 4 reactions had increased ED transfers and hospital admissions.
Conclusions: In this first application of the SGS-AR, outcomes of post-epinephrine monitoring time, disposition, and the use of epinephrine correlated with severity grade during OFC allergic reactions. Next, we will retrospectively validate and assess reliability amongst reviewers of differing experience levels. We also developed a mobile application for real time scoring and prospective data collection.