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. Author manuscript; available in PMC: 2022 Feb 1.
Published in final edited form as: Emerg Med Clin North Am. 2021 Oct 29;40(1):1–17. doi: 10.1016/j.emc.2021.08.007

Fig. 1.

Fig. 1.

Severity grading system for acute allergic reactions. aFor patients with multiple symptoms, reaction severity is based on the most severe symptom; symptoms that constitute more severe grades always supersede symptoms from less severe grades. The grading system can be used to assign reaction severity at any time during the course of reactions; reactions may progress rapidly (within minutes) from one severity grade to another. The grading system does not dictate management decisions; reactions of any severity grade may require treatment with epinephrine. bPatients with severe cardiovascular and/or neurologic involvement may have urinary or stool incontinence. However, the significance of incontinence as an isolated symptom is unclear, and it is therefore not included as a symptom in the subgrading system. cAbdominal pain may also result from uterine cramping. (From Dribin TE, Schnadower D, Spergel JM, et al. Severity grading system for acute allergic reactions: a multidisciplinary Delphi study J Allergy Clin Immunol 2021;148(1):173–181: with permission.)