Evaluating Hymenoptera Venom Allergy Severity: A Data-Centric Comparison of Grading Instruments.

IF 2.5 4区 医学 Q3 ALLERGY International Archives of Allergy and Immunology Pub Date : 2024-01-01 Epub Date: 2024-03-19 DOI:10.1159/000537680
Mark Kačar, Mitja Košnik
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Abstract

Introduction: While a consensus seems to have been reached with regard to the definition of anaphylaxis, there is no universal instrument for scoring allergic reaction severity despite more than 30 having been proposed by the time of writing. This severely hampers comparison of data between studies. While scales have been compared with regard to their utility in grading food-related reactions, no such comparisons have been made for Hymenoptera venom-associated reactions.

Methods: The study conducted a retrospective analysis to compare the severity of Hymenoptera venom allergy reactions in 104 participants with suspected Hymenoptera venom allergy. The study applied six grading instruments to each reaction, also evaluating them against the NIAID/FAAN anaphylaxis criteria. Sensitivity, specificity, and receiver operating characteristic area under the curve (AUC) for identifying anaphylaxis were calculated. Severity scales were simplified into "mild," "moderate," and "severe" categories. The most common severity grade across the five scales was determined using a custom function to establish a consensus severity grade.

Results: The most common culprit insects were honeybees (49.0%). Among the 88 participants with generalized reactions, the highest proportion had involvement of four organ systems. The scales showed high specificity for detecting anaphylaxis, especially when using higher grades of the Mueller, WAO, and Dribin scales. The diagnostic yields (AUC) varied, with the WAO scale having the highest AUC (0.94) for grades 3, 4, and 5. Spearman correlation analysis showed the strongest correlations seen between the Brown and Dribin, Ring and Messmer and Dribin, and Ring and Messmer and Reisman scales. The lowest correlations were observed with the Mueller scale when paired with the WAO, Reisman, and Dribin scales. An inter-rater reliability analysis showed substantial agreement between scales with the same number of grading levels. The agreement was highest for the Brown and Dribin scales, indicating a strong consistency in reaction severity classification across different instruments.

Conclusion: While all instruments were effective in stratifying reactions, they showed limitations in differentiating milder phenotypes. The Brown and Dribin scales stood out for their high agreement with the consensus score and sensitivity in identifying anaphylaxis. Our findings suggest that adopting either of these scales could significantly unify the reporting of allergic reactions. We believe the format of an instrument should be tailored to its intended purpose, with clinical decision aids being simpler and research tools being more detailed.

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评估膜翅目昆虫毒液过敏的严重程度:以数据为中心的分级工具比较。
导言:尽管过敏性休克的定义似乎已达成共识,但过敏反应严重程度的评分方法却没有通用的工具,尽管在撰写本报告时已提出了 30 多种评分方法。这严重阻碍了不同研究之间的数据比较。虽然已经比较了各种量表在对与食物有关的反应进行分级方面的实用性,但还没有对与膜翅目昆虫毒液有关的反应进行过此类比较:该研究对 104 名疑似膜翅目昆虫毒液过敏的参与者进行了回顾性分析,以比较膜翅目昆虫毒液过敏反应的严重程度。该研究对每种反应采用了六种分级工具,并根据 NIAID/FAAN 过敏性休克标准对其进行了评估。计算了识别过敏性休克的灵敏度、特异性和接收器工作特征曲线下面积(AUC)。严重程度等级被简化为 "轻度"、"中度 "和 "重度"。使用自定义函数确定了五个量表中最常见的严重程度等级,从而建立了一致的严重程度等级:结果:最常见的致病昆虫是蜜蜂(49.0%)。在88名出现全身反应的参与者中,涉及四个器官系统的比例最高。量表在检测过敏性休克方面显示出较高的特异性,尤其是在使用较高等级的穆勒、WAO 和 Dribin 量表时。诊断收益率(AUC)各不相同,WAO 量表 3、4 和 5 级的 AUC 最高(0.94)。斯皮尔曼相关分析表明,Brown 和 Dribin 量表、Ring 和 Messmer 和 Dribin 量表以及 Ring 和 Messmer 和 Reisman 量表之间的相关性最强。穆勒量表与 WAO、Reisman 和 Dribin 量表的相关性最低。评分者之间的信度分析表明,分级数量相同的量表之间的一致性很高。布朗量表和德里宾量表的一致性最高,这表明不同工具在反应严重程度分级方面具有很强的一致性:结论:虽然所有工具都能有效地对反应进行分层,但它们在区分较轻的表型方面存在局限性。布朗量表和德里宾量表在识别过敏性休克方面与共识评分的一致性和灵敏度较高,因此脱颖而出。我们的研究结果表明,采用其中任何一种量表都能极大地统一过敏反应的报告。我们认为工具的格式应符合其预期目的,临床决策辅助工具应更简单,而研究工具则应更详细。
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来源期刊
CiteScore
5.60
自引率
3.60%
发文量
105
审稿时长
2 months
期刊介绍: ''International Archives of Allergy and Immunology'' provides a forum for basic and clinical research in modern molecular and cellular allergology and immunology. Appearing monthly, the journal publishes original work in the fields of allergy, immunopathology, immunogenetics, immunopharmacology, immunoendocrinology, tumor immunology, mucosal immunity, transplantation and immunology of infectious and connective tissue diseases.
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