Table 2.

Comparison of existing allergic reaction scoring systems

Category	Gold et al,23 2023	Chinthrajah et al,22 2022	Dribin et al,21 2021	Cox et al,20 2017	Niggeman and Beyer,19 2015	Astier et al,182006	Hourihane et al,17 2005	Ewan and Clark,16 2005	Brown,15 2004	Sampson,14 2003	Lockey et al,13 1988	Ring and Messmer,12 1977	Mueller,11 1959
Stakeholders involved in development	Allergists, public health safety officials—International	Allergists, industry partners—United States	Allergists, general and pediatric ED physicians—United States	Allergists, industry partners, health regulatory authorities—International	Allergists—Germany	Allergists—United States, France	Allergists—United Kingdom	Allergists—United Kingdom	Emergency medicine physician—Australia	Allergists—United States	Allergists—United States	Allergists— Germany	Allergists—United States
Methods	Expert opinion	Expert opinion	Delphi	Expert opinion	Expert opinion	Expert opinion	Expert opinion	Expert opinion	Recursive Partitioning	Expert opinion	Expert opinion	Expert opinion	Expert opinion
Scale	1–3	1–5	1–5	1–5	1–3	1–5	5 levels	1–5	1–3	1–5	3 levels	1–4	4 levels
Is anaphylaxis defined at a particular grade?	All 3 levels describe anaphylaxis	No	No	Yes, grade 4 and 5	Yes, grade 3	No	Severe reaction is defined at a score of ≥ 14	Severe reaction is defined as grade 5	Moderate and severe reactions (grade 2 and 3) are categorized as anaphylaxis	Bolded symptoms are identified as absolute indications for epinephrine	Severe reaction is defined	No	Severe allergic reaction and shock are identified
Allergen Specific?	Vaccine	Food	No	Initially designed for aeroallergen IT, but later modified to be used with any allergenic trigger	No	Food	Food, specifically designed to grade reactions during peanut OFC	Food	No	Food	Venom IT	Colloid volume substance	Venom from insect stings
Age Specific?	All ages	All ages	All ages	All ages	All ages	Some criteria not applicable to infants, and alternative criteria not provided (eg, abdominal pain)	All ages	Some criteria not applicable to infants (eg, “mild asthma”)	Some criteria not applicable for young children/ infants (eg, hypotension criteria only listed for adults)	All ages	All ages	Children and infant specific criteria not available for certain criteria (eg, tachy-cardia, hypotension)	Some criteria not applicable to infants, and alternative criteria not provided (eg, dizziness, confusion, feeling of impending disaster)
Organ Systems	Skin	Skin	Skin	Skin	Skin	Skin	Skin	Skin	Skin	Skin	Skin	General (eg, fever)	Skin
Involved	GI	GI	GI	GI	GI	GI	GI	GI	GI	GI	GI	Skin	GI
	CV	CV	CV	CV	CV	CV	CV	CV	CV	CV	CV	GI	CV
	Upp Resp	Upp Resp	Lwr Resp	Upp Resp	Lwr Resp	Lwr Resp	Lwr Resp	Lwr Resp	Lwr Resp	Upp Resp	Lwr Resp	CV	Lwr Resp
	Lwr Resp	Lwr Resp	Neuro	Lwr Resp				Neuro	Neuro	Lwr Resp Neuro		Lwr Resp	Neuro
Subjective Criteria?	None	None	None	None	None	None	Yes; eg, “severe respiratory symptoms”	Yes; eg, “pronounced dyspnea”	Yes; eg, “dyspnea”	Yes; eg, mild lip swelling is listed as Grade I GI symptoms whereas angioe- dema is listed as Grade II cutaneous symptom. The same symptom can be classified differently depending on the observer	Yes; eg, “GI symptoms” is listed as criterion for a moderate systemic reaction, but does not detail what specific symptoms qualify	Yes; eg, “mild but not life-threatening respiratory disturbance”	Yes; eg, “dyspnea”
Nonspecific scale elements?	None	None	None	None	Yes; eg, specific criteria for hypotension and tachycardia notoutlined	Yes; eg, specific criteria for hypotension is not outlined	Yes; eg, “severe respiratory symptoms” is not outlined further	Yes; eg, “GI symptoms” is not outlined further	None	Yes; eg, mild hypotension is a criterion but not defined	Yes; eg, there is an “other” criterion without details	Yes; eg, “measurable but not life- threatening GI disturbance or respiratory disturbance” not outlined further	Yes; eg, “fall in blood pressure” is listed but not defined (continued)
Treatment of symptoms affect grading?	No	Yes, cough responding to short broncho- dilator treatment is classified at a lower severity than are lower respiratory symptoms that are refractory to treatment	No	Does not mention specific medications, but does consider response to “treatment” in establishing grade	No	Does not mention specific medications but does consider response to “treatment” in establishing grade	No	No	No	No	No	No	No
Non-sign or symptom criteria	Laboratory values are part of determining level						Final score depends on amount of peanut consumed

Abbreviations: CV, cardiovascular; GI, gastrointestinal; IT, immunotherapy; Lwr Resp, lower respiratory; Neuro, neurologic; OFC, oral food challenge; Upp Resp, upper respiratory