Dataset Information

WAO consensus on DEfinition of Food Allergy SEverity (DEFASE).

ABSTRACT:

Background

While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole.

Aim

To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring system, to be used globally.

Methods phase 1

We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts.

Phase 2

Based on our findings in Phase 1, we drafted statements for a two-round modified electronic Delphi (e-Delphi) survey. A purposefully selected multidisciplinary international expert panel on food allergy (n = 60) was identified and sent a structured questionnaire, including a set of statements on different domains of food allergy severity related to symptoms, health-related quality of life, and economic impact. Participants were asked to score their agreement on each statement on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". Median scores and percentage agreements were calculated. Consensus was defined a priori as being achieved if 70% or more of panel members rated a statement as "strongly agree" to "agree" after the second round. Based on feedback, 2 additional online voting rounds were conducted.

Results

We received responses from 92% of Delphi panel members in round 1 and 85% in round 2. Consensus was achieved on the overall score and in all of the 5 specific key domains as essential components of the DEFASE score.

Conclusions

The DEFASE score is the first comprehensive grading of food allergy severity that considers not only the severity of a single reaction, but the whole disease spectrum. An international consensus has been achieved regarding a scoring system for food allergy disease. It offers an evaluation grid, which may help to rate the severity of food allergy. Phase 3 will involve validating the scoring system in research settings, and implementing it in clinical practice.

SUBMITTER: Arasi S

PROVIDER: S-EPMC9996094 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

WAO consensus on DEfinition of Food Allergy SEverity (DEFASE).

Arasi Stefania S Nurmatov Ulugbek U Dunn-Galvin Audrey A Roberts Graham G Turner Paul J PJ Shinder Sayantani B SB Gupta Ruchi R Eigenmann Philippe P Nowak-Wegrzyn Anna A Ansotegui Ignacio J IJ Rivas Montserrat Fernandez MF Petrou Stavros S Tanno Luciana K LK Vazquez-Ortiz Marta M Vickery Brian B Wong Gary G Alvaro-Lozano Montserrat M Asaria Miqdad M Begin Philippe P Bozzola Martin M Boyle Robert R Brough Helen H Cardona Victoria V Chinthrajah R Sharon RS Cianferoni Antonella A Deschildre Antoine A Fleischer David D Gazzani Flavio F Gerdts Jennifer J Giannetti Marilena M Greenhawt Matthew M Guzmán Maria Antonieta MA Hossny Elham E Kauppi Paula P Jones Carla C Lucidi Francesco F Monge Ortega Olga Patricia OP Munblit Daniel D Muraro Antonella A Pajno Giovanni G Podestà Marcia M Rodriguez Del Rio Pablo P Said Maria M Santos Alexandra A Shaker Marcus M Szajewska Hania H Venter Carina C Warren Cristopher C Winders Tonya T Ebisawa Motohiro M Fiocchi Alessandro A

The World Allergy Organization journal 20230302 3

<h4>Background</h4>While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole.<h4>Aim</h4>To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring system, to be used globally.<h4>Methods phase 1</h4>We conducted a mixed-method systematic review (SR) of 11 databases for published and unpub ...[more]

PMID: 36910595

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Project description:Background and aimsThe term "Food Allergy" refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders.MethodsWe undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed.ResultsWe found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate.ConclusionsThere is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy.Systematic review registrationA protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).

Project description:BackgroundThe prevalence of cow's milk allergy (CMA) is approximately 2-4.5% in infants and less than 0.5% in adults. Most children outgrow cow's milk allergy in early childhood, particularly that to the baked milk products. Immunotherapy with unheated cow's milk has been used as a treatment option for those who have not yet outgrown CMA, but the benefits must be balanced with the adverse effects.ObjectiveThese evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of oral and epicutaneous immunotherapy for the treatment of IgE-mediated CMA.MethodsWAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment.ResultsAfter a careful review of the summarized evidence and thorough discussions the WAO guideline panel suggests: a) using oral immunotherapy with unheated cow's milk in those individuals with confirmed IgE-mediated CMA who value the ability to consume controlled quantities of milk more than avoiding the large adverse effects of therapy, b) not using oral immunotherapy with unheated cow's milk in those who value avoiding large adverse effects of therapy more than the ability to consume controlled quantities of milk, c) using omalizumab in those starting oral immunotherapy with unheated cow's milk, d) not using oral immunotherapy with baked cow's milk in those who do not tolerate both unheated and baked milk, and e) not using epicutaneous immunotherapy outside of a research setting. The recommendations are labeled "conditional" due to the low certainty about the health effects based on the available evidence.ConclusionsClinicians, patients, and their family members might want to discuss all the potential desirable and undesirable effects of oral immunotherapy for IgE-mediated CMA and integrate them with the patients' values and preferences before deciding on a treatment option. More robust research is needed to determine with greater certainty which interventions are likely to be the most beneficial with the least harms, and to develop safer, low-cost, and equitable treatments.

Dataset Information

WAO consensus on DEfinition of Food Allergy SEverity (DEFASE).

Background

Aim

Methods phase 1

Phase 2

Results

Conclusions

Publications

WAO consensus on DEfinition of Food Allergy SEverity (DEFASE).

Similar Datasets

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