Journal of Allergy and Clinical Immunology ( IF 14.2 ) Pub Date : 2020-08-24 , DOI: 10.1016/j.jaci.2020.08.015 Timothy E Dribin 1 , Hugh A Sampson 2 , Carlos A Camargo 3 , David C Brousseau 4 , Jonathan M Spergel 5 , Mark I Neuman 6 , Marcus Shaker 7 , Ronna L Campbell 8 , Kenneth A Michelson 6 , Susan A Rudders 9 , Amal H Assa'ad 10 , Kimberly A Risma 10 , Mariana Castells 11 , Lynda C Schneider 9 , Julie Wang 2 , Juhee Lee 5 , Rakesh D Mistry 12 , David Vyles 4 , Lisa M Vaughn 13 , Daniel J Schumacher 1 , John K Witry 14 , Shiv Viswanathan 14 , Erica M Page 15 , David Schnadower 1
Background
The use of inconsistent definitions for anaphylaxis outcomes limits our understanding of the natural history and epidemiology of anaphylaxis, hindering clinical practice and research efforts.
Objective
Our aim was to develop consensus definitions for clinically relevant anaphylaxis outcomes by utilizing a multidisciplinary group of clinical and research experts in anaphylaxis.
Methods
Using Delphi methodology, we developed agenda topics and drafted questions to review during monthly conference calls. Through online surveys, a 19-member panel consisting of experts in allergy and/or immunology and emergency medicine rated their level of agreement with the appropriateness of statements on a scale of 1 to 9. A median value of 1.0 to 3.4 was considered inappropriate, a median value of 3.5 to 6.9 was considered uncertain, and a median value of 7.0 to 9.0 was considered appropriate. A disagreement index was then calculated, with values less than 1.0 categorized as “consensus reached.” If consensus was not reached after the initial survey, subsequent surveys incorporating the aggregate de-identified responses from prior surveys were sent to panel members. This process was repeated until consensus was reached or 4 survey rounds had been completed, after which the question was categorized as “no consensus reached.”
Results
The panel developed outcome definitions for persistent, refractory, and biphasic anaphylaxis, as well as for persistent and biphasic nonanaphylactic reactions. There was also consensus among panel members regarding the need to develop an anaphylaxis severity grading system.
Conclusion
Dissemination and application of these definitions in clinical care and research will help standardize the terminology used to describe anaphylaxis outcomes and serve as the foundation for future research, including research aimed at development of an anaphylaxis severity grading system.
中文翻译:
持久性,难治性和双相过敏反应:Delphi多学科研究。
背景
对过敏反应结果使用不一致的定义限制了我们对过敏反应的自然史和流行病学的理解,从而阻碍了临床实践和研究工作。
目的
我们的目的是通过利用多学科的过敏反应临床和研究专家小组,为临床相关的过敏反应结果制定共识定义。
方法
使用Delphi方法,我们制定了议程主题并草拟了问题,以便在每月电话会议期间进行审查。通过在线调查,由过敏和/或免疫学和急诊医学专家组成的19人小组对他们的同意水平和陈述的适当性进行了评分,以1到9的等级进行评估。认为中位数为1.0到3.4是不适当的,中位数3.5到6.9被认为是不确定的,中位数7.0到9.0被认为是合适的。然后计算出分歧指数,将小于1.0的值归类为“达成共识”。如果在初次调查后仍未达成共识,则将合并了先前调查中未识别出的总计答复的后续调查发送给小组成员。
结果
专家组为持续性,难治性和双相过敏反应以及持续性和双相非过敏反应制定了结果定义。专家组成员之间就是否需要建立过敏性严重程度分级系统也达成了共识。
结论
这些定义在临床护理和研究中的传播和应用将有助于标准化用于描述过敏反应结果的术语,并为包括旨在开发过敏严重程度分级系统的研究在内的未来研究奠定基础。