CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

ANAPHYLAXIS GRADING SYSTEMS

Asena Pınar Sefer

Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Pediatric Immunology and Allergic Diseases, Rize, Türkiye

Sefer AP. Anaphylaxis Grading Systems. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.201-213.

ABSTRACT

Anaphylaxis is a rapid-onset allergic reaction affecting multiple systems. It poses significant diagnostic and management challenges, especially in children due to its variable clinical presentation and the lack of a universally accepted severity grading system. This section focuses on the pediatric population, addressing existing anaphylaxis grading systems’ clinical use, strengths, and limitations. Systems such as the Brown classification, the European Academy of Allergy and Clinical Immunology (EAACI) criteria, the World Allergy Organization (WAO) scales, and the Dribin system have been compared in terms of physiological markers, objective measurements, and age-specific criteria. Brown’s pioneering approach, which links the need for epinephrine to symptom severity, remains limited due to its reliance on observable findings and the absence of pediatric thresholds. In contrast, modern systems like WAO’s 2024 update and the Dribin system include dynamic assessments, treatment responses, and pediatric adaptations, yet they face complexity and global applicability challenges. In young children with undeveloped language skills, the inability to verbalize symptoms, frequent gastrointestinal manifestations such as vomiting and diarrhea during normal infancy, and atypical presentations (e.g., irritability) can limit the effectiveness of existing grading systems. Additionally, cultural and regional variations in allergen prevalence (e.g., peanuts in the West, shellfish in Asia) necessitate the adaptability of these systems. Creating a universal grading system necessitates global collaboration, extensive validation studies, and the engagement of patients and their caregivers. This system should be both succinct and thorough, allowing for practical use in routine scenarios while facilitating smooth integration into electronic health records. Ultimately, patient-centered, data-driven, and culturally sensitive grading systems can significantly improve diagnostic accuracy, communication, and treatment outcomes in pediatric anaphylaxis management.

Keywords: Anaphylaxis; Anaphylaxis grading system; Pediatric anaphylaxis

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