Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report

Table 4 Grading of systemic side effects (SCIT and SLIT) (simplified from 59)

GRADE 1	GRADE 2	GRADE 3	GRADE 4	GRADE 5
Symptoms/signs of one organ/system ● Cutaneous: generalized pruritus, urticaria, flushing. OR ● Angioedema (not tongue, laryngeal or uvular) OR ● Upper respiratory: rhinitis, cough OR ● conjunctivitis	Symptoms/signs of one organ/system OR ● Lower respiratory: asthma, cough with wheezing, chest tightness, shortness of breath. Fall <40% PEF, responding to SABA OR ● Gastrointestinal: abdominal cramps, vomiting, or diarrhea OR ● Uterine cramps	● Lower respiratory Asthma (eg, >40% fall PEF or FEV1) NOT responding to an inhaled bronchodilator OR ● Upper respiratory: laryngeal, uvula, or tongue edema with or without stridor	● Lower or upper respiratory: respiratory failure with or without loss of consciousness OR ● Cardiovascular: hypotension with or without loss of consciousness	Death

Patients may also have a feeling of impending doom, especially in grades 2, 3, or 4. Note: Children with anaphylaxis seldom convey a sense of impending doom and their behavior changes may be a sign of anaphylaxis; eg, becoming very quiet or irritable and cranky. Scoring includes a suffix that denotes if and when epinephrine is or is not administered in relationship to onset of symptom(s)/sign(s) of the SR:a, 5 min; b, >5 min to 10 min; c: >10 to 20 min; d:>20 min; z, epinephrine not administered. The final grade of the reaction will not be determined until the event is over, regardless of the medication administered. The final report should include the first symptom(s)/sign(s) and the time of onset after the allergen immunotherapy administration and a suffix reflecting if and when epinephrine was or was not administered, eg, Grade 2a; rhinitis:10 min. Symptoms occurring within the first minutes after the administration may be a sign of severe anaphylaxis.
Final Report: Grade a–d, or z__________ First symptom(s)/sign(s)___________ Time of onset of first symptom_____________

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