Volume 125, Issue 3 , Pages 569-574.e7, March 2010
Speaking the same language: The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System
Subcutaneous allergen immunotherapy (SCIT) is an effective treatment for allergic rhinitis, asthma and venom hypersensitivity and has the potential of producing serious life-threatening anaphylaxis. Adverse reactions are generally classified into 2 categories: local reactions, which can manifest as redness, pruritus, and swelling at the injection site, and systemic reactions (SRs). SRs can range in severity from mild rhinitis to fatal cardiopulmonary arrest. Early administration of epinephrine, which is the treatment of choice to treat anaphylaxis, may prevent the progression of an SR to a more serious life-threatening problem. Although there is little debate about using epinephrine to treat a SCIT SR, there is a lack of consensus about when it should be first used. A uniform classification system for grading SCIT SRs will be helpful in assessing more accurately when epinephrine should be administered. The primary purpose of this article is to discuss the proposed grading system for SCIT SRs.
Key words: Subcutaneous allergen immunotherapy, anaphylaxis grading system, systemic reaction grading system, allergic rhinitis, asthma
Abbreviations used: AAAAI, American Academy of Allergy, Asthma & Immunology, ACAAI, American College of Allergy, Asthma & Immunology, BP, Blood pressure, EAACI, European Academy of Allergy and Clinical Immunology, PEF, Peak expiratory flow, SCIT, Subcutaneous immunotherapy, SR, Systemic reaction, WAO, World Allergy Organization
Disclosure of potential conflict of interest: D. Larenas-Linnemann receives honoraria from Schering-Plough and MSD, receives grants from ALK-Abelló and Stallergenes, and receives research support from ALK-Abelló, Stallergenes, and Alerquim de Mexico. S. Dreborg receives grant support from ALK-Abelló, Hørsholm, Denmark; has provided legal consultation/expert witness testimony for MEDECA Pharma AB Sweden; and serves on the editorial boards of Pediatric Allergy and Immunology and the Annals of Allergy, Asthma, and Immunology. D. Bernstein is a consultant for ALK-America and Schering-Plough, receives grant support from Schering-Plough, and is on the ACAAI Board of Regents. E. Valovirta is a lecturer for Merck, is a consultant for ALK-Abelló, receives honoraria from ALK-Abelló, and receives research support from Merck and Allergopharma. J. Bousquet is a member of the Stallergenes board and has received lecture fees from ALK. M. Calderon receives honoraria from ALK-Abelló, Denmark, and Schering-Plough and receives research support from ALK-Abelló, Denmark. D. Ledford owns stock in AstraZeneca and Merck; is a consultant for Novartis, Genentech, and Take Care Health Systems; is on the advisory board for Novartis, Genentech, and AstraZeneca; is a speaker for Novartis, Genentech, AstraZeneca, Schering, Merck, SepraCorp, SanofiAventis, and UCB; receives honoraria from Novartis, Genentech, AstraZeneca, Schering, Merck, SepraCorp, SanofiAventis, and UCB; and receives research support from Genentech, Forest, AstraZeneca, and Take Care Health Systems. H. Nelson is a consultant for Genentech, Novartis, Abbott, Medicinova, Amgen, Dyson, Sepracor, GSK, AstraZeneca, and Schering-Plough; is on the speakers' bureau for GlaxoSmithKline; and receives research support from Schering-Plough, AstraZeneca, Genentech, and Ception. The rest of the authors have declared that they have no conflict of interest.
The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System was developed by The Joint Task Force for Grading Systemic Reactions to Immunotherapy. Members of this task force include the editors of this article and the following authors listed alphabetically: David Bernstein, MD, Jean Bousquet, MD, Moises Calderon, MD, PhD, Walter Canonica, MD, Thomas B. Casale, MD, Sten Dreborg, MD, PhD, Dennis Ledford, MD, Harold Nelson, MD, and Erkka Valovirta, MD, PhD. The comments of Joint Task Force for Grading Systemic Reactions members and invited reviewers are posted in this article's Online Repository at www.jacionline.org.
PII: S0091-6749(09)01638-8
doi:10.1016/j.jaci.2009.10.060
© 2010 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Volume 125, Issue 3 , Pages 569-574.e7, March 2010
