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WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)

Authors :: Stefania Arasi, MD, PhD, MSc
Ulugbek Nurmatov, MD
Audrey Dunn-Galvin, PhD
Graham Roberts, DM
Paul J. Turner, FRCPCH, PhD
Sayantani B. Shinder, MD, PhD
Ruchi Gupta, MD, MPh
Philippe Eigenmann, MD
Anna Nowak-Wegrzyn, MD, PhD
Ignacio J. Ansotegui, MD, PhD
Montserrat Fernandez Rivas, MD
Stavros Petrou, PhD
Luciana K. Tanno, MD, PhD
Marta Vazquez-Ortiz, MD, PhD
Brian Vickery, MD, PhD
Gary Wong, MD, FRCPC
Montserrat Alvaro-Lozano, MD, PhD
Miqdad Asaria, PhD
Philippe Begin, MD, MSc
Martin Bozzola, MD
Robert Boyle, MD
Helen Brough, MD, PhD
Victoria Cardona, MD, PhD
R. Sharon Chinthrajah, MD, PhD
Antonella Cianferoni, MD
Antoine Deschildre, MD
David Fleischer, MD
Flavio Gazzani, PhD
Jennifer Gerdts
Marilena Giannetti, PhD
Matthew Greenhawt, MD, MBA, MSc
Maria Antonieta Guzmán, MD
Elham Hossny, MD, PhD, FAAAAI
Paula Kauppi, MD
Carla Jones
Francesco Lucidi, PhD
Olga Patricia Monge Ortega, MD, PhD
Daniel Munblit, MD, PhD
Antonella Muraro, MD
Giovanni Pajno, MD
Marcia Podestà
Pablo Rodriguez del Rio, MD, PhD
Maria Said
Alexandra Santos, MD, MSc, MRCPCH, PGCAP, FHEA, PhD
Marcus Shaker, MD
Hania Szajewska, MD, PhD
Carina Venter, PhD
Cristopher Warren, PhD
Tonya Winders
Motohiro Ebisawa, MD, PhD
Alessandro Fiocchi, MD
Source :: World Allergy Organization Journal, Vol 16, Iss 3, Pp 100753- (2023)
Publication Year :: 2023
Publisher :: Elsevier, 2023.
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 Methods: Phase 1: We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts.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.