Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar;36(3):e70065.
doi: 10.1111/pai.70065.

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

Yanis Bouderbala  1 , Evangéline Clark  2   3 , Luciana Kase Tanno  1   3   4 , Pascal Demoly  1   3   4 , Davide Caimmi  1   3
Affiliations
Observational Study

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

Yanis Bouderbala et al. Pediatr Allergy Immunol. 2025 Mar.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: ICD‐11; adrenaline; anaphylaxis; classifications; severity.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflict of interest for the present paper.

Figures

FIGURE 1
FIGURE 1
Distribution of foods causing any allergic reactions in our group of 235 patients (A) and in the subgroup of 143 anaphylactic patients (B).
FIGURE 2
FIGURE 2
Distribution of anaphylactic and non‐anaphylactic reactions recorded during the oral challenge, with the main tested foods (A) and with tree nuts (B).
See this image and copyright information in PMC

References

    1. Pouessel G, Turner PJ, Worm M, et al. Food‐induced fatal anaphylaxis: from epidemiological data to general prevention strategies. Clin Exp Allergy. 2018;48(12):1584‐1593. - PubMed
    1. Panesar SS, Javad S, de Silva D, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68(11):1353‐1361. doi: 10.1111/all.12272 - DOI - PubMed
    1. Tanno LK, Demoly P. Epidemiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2021;21(2):168‐174. - PubMed
    1. Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1(8009):466‐469. - PubMed
    1. Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. - PMC - PubMed

Publication types