Comparison of International Systemic Adverse Reactions due to Allergen Immunotherapy

Publication date: Available online 14 December 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Carmen Vidal, Pablo Rodríguez del Río, Francisco Gude, Thomas Casale, Linda Cox, Jocelyne Just, Oliver Pfaar, Pascal Demoly, Moises A. Calderón

Abstract

Background

Several classifications of systemic adverse reactions (SAR) during allergen immunotherapy (AIT) have been proposed but the comparison of their usefulness in daily clinical practice is lacking.

Objective

The present post hoc analysis was aimed to investigate the practicality of the most relevant international classifications proposed by the European Academy of Allergology and Clinical Immunology (EAACI), the American Academy of Asthma, Allergology and Clinical Immunology /American College of Allergy, Asthma and Immunology (AAAACI/ACAAI), and the World Allergy Organization (WAO) using data provided by the longitudinal European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI) based on daily clinical practice in 3 countries in Europe.

Methods

One hundred and nine SAR over 4363 AIT courses were classified as mild (n=78, 71.5%), moderate (n=27, 24.8%) and severe (n=4, 3.7%) by EASSI-doctors, which served as a gold standard. Every SAR was further classified according to EAACI, WAO 2010 and 2017 and AAAAI/ACAAI grading systems. All SAR rankings were also cross-compared among each other (Kendall correlation coefficient Tau-b). In general, a low epinephrine use was identified, severe reactions occurred within 15 min, milder reactions were skin only.

Results

The analysis indicated disparities in mild and moderate SAR in the different grading systems. The correlation between EASSI-severity and EAACI, WAO 2010, WAO 2017 and AAAAIA/ACAAI was 0.639, 0.502, 0.315, and 0.663 (p<0.001 in all cases). However, correlation of severe reactions was good. The best correlation with the onset of the reaction and the number of System Organ Class (SOC) involved were detected in WAO grading systems.

Conclusion

Despite having a lower correlation than EAACI and AAAAI/ACAAI, the WAO grading appears to provide a moderate correlation among these classifications. The analysis might help to inform clinicians and investigators on selecting the most appropriate classification.

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