United States Drug Allergy Registry (USDAR) Grading Scale for Immediate Drug Reactions

Overview

Journal J Allergy Clin Immunol

Specialty Allergy & Immunology

Date 2023 Aug 31

PMID 37652140

Authors

David A Khan

Elizabeth J Phillips

John J Accarino

Alexei Gonzalez-Estrada

Iris M Otani

Allison Ramsey

Anna Chen Arroyo

Aleena Banerji

Timothy Chow

Anne Y Liu

Cosby A Stone Jr

Kimberly G Blumenthal

Affiliations

Soon will be listed here.

Abstract

Background: There is no accepted grading system classifying the severity of immediate reactions to drugs.

Objective: The purpose of this article is to present a proposed grading system developed through the consensus of drug allergy experts from the United States Drug Allergy Registry (USDAR) Consortium.

Methods: The USDAR investigators sought to develop a consensus severity grading system for immediate drug reactions that is applicable to clinical care and research.

Results: The USDAR grading scale scores severity levels on a scale of 0 to 4. A grade of no reaction (NR) is used for patients who undergo challenge without any symptoms or signs, and it would confirm a negative challenge result. A grade 0 reaction is indicative of primarily subjective complaints that are commonly seen with both historical drug reactions and during drug challenges, and it would suggest a low likelihood of a true drug allergic reaction. Grades 1 to 4 meet the criteria for a positive challenge result and may be considered indicative of a drug allergy. Grade 1 reactions are suggestive of a potential immediate drug reaction with mild symptoms. Grade 2 reactions are more likely to be immediate drug reactions of moderate severity. Grade 3 reactions have features suggestive of a severe allergic reaction, whereas grade 4 reactions are life-threatening reactions such as anaphylactic shock and fatal anaphylaxis.

Conclusion: This proposed grading schema for immediate drug reactions improves on prior schemata by being developed specifically for immediate drug reactions and being easy to implement in clinical and research practice.

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