Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
Symptom(s)/sign(s) of one organ system present* Cutaneous Generalized pruritus, urticaria, flushing, or sensation of heat or warmth¶ or Angioedema (not laryngeal, tongue, or uvular) or Upper respiratory Rhinitis (eg, sneezing, rhinorrhea, nasal pruritus, and/or nasal congestion) or Throat-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 or Lower respiratory Asthma: Cough, wheezing, shortness of breath (eg, less than 40% PEF or FEV1 drop, responding to an inhaled bronchodilator) or Gastrointestinal Abdominal cramps, vomiting, or diarrhea or Other Uterine cramps | Lower respiratory Asthma (eg, 40% PEF or FEV1 drop not responding to an inhaled bronchodilator) or Upper respiratory Laryngeal, uvula, or tongue edema with or without stridor | Lower or upper respiratory Respiratory failure with or without loss of consciousness or Cardiovascular Hypotension with or without loss of consciousness | Death |
Patients may 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 may be a sign of anaphylaxis (eg, 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 onset of symptom(s)/sign(s) of the systemic reaction: a: ≤5 minutes; b: >5 minutes to ≤10 minutes; c: >10 to ≤20 minutes; d: >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 after the subcutaneous allergen immunotherapy injectionΔ and a suffix reflecting if and when epinephrine was or was not administered (eg, Grade 2a; rhinitis: 10 minutes). | ||||
Final report: Grade a to d or z___________ First symptom(s)/sign(s)___________ Time of onset of first symptom___________ | ||||
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