Development and validation of the food allergy severity score. Issue 5 (12th November 2021)

• Record Type: Journal Article
• Authors: Fernández‐Rivas, Montserrat; Gómez García, Ismael; Gonzalo‐Fernández, Alejandro; Fuentes Ferrer, Manuel; Dölle‐Bierke, Sabine; Marco‐Martín, Guadalupe; Ballmer‐Weber, Barbara K.; Asero, Riccardo; Belohlavkova, Simona; Beyer, Kirsten; de Blay, Frédéric; Clausen, Michael; Datema, Mareen R.; Dubakiene, Ruta; Grimshaw, Kate E. C.; Hoffmann‐Sommergruber, Karin; Hourihane, Jonathan O'B; Jedrzejczak‐Czechowicz, Monika; Knulst, André C.; Kralimarkova, Tanya; Le, Thuy‐My; Papadopoulos, Nikolaos G.; Popov, Todor A.; Poulsen, Lars K.; Purohit, Ashok; Seneviratne, Suranjith L.; Simpson, Angela; Sinaniotis, Atanasios; Turkalji, Mirjana; Vázquez‐Cortés, Sonia; Vera‐Berrios, Rosialzira N.; Muraro, Antonella; Worm, Margitta; Roberts, Graham; van Ree, Ronald; Fernández‐Pérez, Cristina; Turner, Paul J.; Mills, Elizabeth N. Clare;
• Is Part Of: Allergy. Volume 77:Issue 5(2022)
• Page Start: 1545
• Page End: 1558
• Publication Date: 2021-11-12
• Subjects: allergic reactions -- anaphylaxis -- food allergy -- score -- severity; Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.15165
• Languages: English
• ISSNs: 0105-4538

Abstract

Abstract: Background: The heterogeneity and lack of validation of existing severity scores for food allergic reactions limit standardization of case management and research advances. We aimed to develop and validate a severity score for food allergic reactions. Methods: Following a multidisciplinary experts consensus, it was decided to develop a food allergy severity score (FASS) with ordinal (oFASS) and numerical (nFASS) formats. oFASS with 3 and 5 grades were generated through expert consensus, and nFASS by mathematical modeling. Evaluation was performed in the EuroPrevall outpatient clinic cohort (8232 food reactions) by logistic regression with request of emergency care and medications used as outcomes. Discrimination, classification, and calibration were calculated. Bootstrapping internal validation was followed by external validation (logistic regression) in 5 cohorts (3622 food reactions). Correlation of nFASS with the severity classification done by expert allergy clinicians by Best‐Worst Scaling of 32 food reactions was calculated. Results: oFASS and nFASS map consistently, with nFASS having greater granularity. With the outcomes emergency care, adrenaline and critical medical treatment, oFASS and nFASS had a good discrimination (receiver operating characteristic area under the curve [ROC‐AUC]>0.80), classification (sensitivity 0.87–0.92, specificity 0.73–0.78), and calibration. Bootstrapping over ROC‐AUC showed negligible biases (1.0 × 10 −6 –1.23 × 10 −3 ). In external validation, nFASS performed best with higher ROC‐AUC. nFASS was strongly correlated (R 0.89) to best‐worst scoring of 334 expert clinicians. Conclusion: FASS is a validated and reliable method to measure severity of food allergic reactions. The ordinal and numerical versions that map onto each other are suitable for use by different stakeholders in different settings. Abstract : FASS with ordinal (oFASS‐3, oFASS‐5) and numerical (nFASS) formats that map consistently was developed by multidisciplinary experts' consensus and mathematical modeling. Following evaluation, internal and external validation, FASS is a validated and reliable method to measure severity of food allergic reactions. oFASS‐3, oFASS‐5, and nFASS are suitable for use by different stakeholders in different settings.Abbreviations: EuroPrevall, Prevalence, Cost and Basis of Food Allergy in Europe; FASS, Food Allergy Severity Score; HCSC, Hospital Clinico San Carlos; iFAAM, European union‐funded project Integrated Approaches to Food Allergen and Allergy Risk Management; NORA, Network for Online Registration of Anaphylaxis; oFASS, ordinal FASS; oFASS‐3, ordinal FASS with 3 grades oFASS‐5, ordinal FASS with 5 grades; SAFE, European union‐funded project Plant food allergies: field to table strategies for reducing their incidence in Europe.