6
Table 4. World Allergy Organization Subcutaneous
Immunotherapy Systemic Reaction Grading System
Grade 1 Grade 2
Symptom(s)/sign(s) of 1 organ system
present
a
Cutaneous
Generalized pruritus, urticaria, flushing, or
sensation of heat or warmth
b
or
Angioedema (not laryngeal, tongue or
uvular)
or
Upper respiratory
Rhinitis — (e.g., sneezing, rhinorrhea,
nasal pruritus and/or nasal congestion)
or
roat-clearing (itchy throat)
or
Cough perceived to originate in the upper
airway, not the lung, larynx, or trachea
or
Conjunctival
Erythema, pruritus or tearing
Other
Nausea, metallic taste, or headache
Symptom(s)/sign(s) of more than one
organ system present
a
or
Lower respiratory
Asthma: cough, wheezing, shortness of
breath (e.g., less than 40% peak expiratory
flow [PEF] or forced expiratory volume
in one second [FEV1] drop, responding
to an inhaled bronchodilator)
or
Gastrointestinal
Abdominal cramps, vomiting, or diarrhea
or
Other
Uterine cramps
a
Each grade is based on organ system involved and severity. Organ systems are defined as cutaneous,
conjunctival, upper respiratory, lower respiratory, gastrointestinal, cardiovascular, and other. A
reaction from a single organ system such as cutaneous, conjunctival, or upper respiratory, but not
asthma, gastrointestinal, or cardiovascular is classified as a grade 1. Symptom(s)/sign(s) from more
than one organ system or asthma, gastrointestinal, or cardiovascular are classified as grades 2 or 3.
Respiratory failure or hypotension with or without loss of consciousness define grade 4 and death
grade 5. e grade is determined by the physician's clinical judgment.
b
is constellation of symptoms may rapidly progress to a more severe reaction.
Reproduced from the Journal of Allerg y and Clinical Immunolog y: In Practice, vol 5, Cox LS,
Sanchez-Borges M, Lockey RF, World Allerg y Organization Systemic Allergic Reaction Grading
System: Is a Modification Needed?, copyright 2020, with permission from Elsevier.
Introduction
