Safety and Patient Selection
Table 3. World Allergy Organization Subcutaneous Systemic Reaction Grading Systema
General
Grade 1 Signs and symptoms of only one organ system
Cutaneous
Generalized pruritus, urticaria, flushing or sensation of heat or warmthb
OR
Angioedema (not larynx, tongue or uvula)
Grade 2 Signs and symptoms of more than one organ system
Conjunctival
Erythema, pruritus or tearing
Grade 3
Grade 4
Grade 5
DEATH
Patients might 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 might be a sign of anaphylaxis, such as becoming very quiet or irritable and cranky. Scoring includes a suffix that denotes if and when epinephrine is or is not administered in relationship to symptoms/signs of the systemic reaction: a, 5 minutes or less; b, greater than 5 minutes to 10 minutes or less; c, greater 10 minutes to 20 minutes or less; d, greater than 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 aſter the subcutaneous allergen immunotherapy injectionc
and a suffix reflecting
if and when epinephrine was or was not administered (eg, Grade2a:rhinitis:10 minutes). Final report: Grade a-d,or z ________________ First symptom_______Time of onset of first symptom______ Commentsd
6
