WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)

Stefania Arasi*, Ulugbek Nurmatov, Audrey Dunn-Galvin, Graham Roberts, Paul J. Turner, Sayantani B. Shinder, Ruchi Gupta, Philippe Eigenmann, Anna Nowak-Wegrzyn, Ignacio J. Ansotegui, Montserrat Fernandez Rivas, Stavros Petrou, Luciana K. Tanno, Marta Vazquez-Ortiz, Brian Vickery, Gary Wong, Montserrat Alvaro-Lozano, Miqdad Asaria, Philippe Begin, Martin BozzolaRobert Boyle, Helen Brough, Victoria Cardona, R. Sharon Chinthrajah, Antonella Cianferoni, Antoine Deschildre, David Fleischer, Flavio Gazzani, Jennifer Gerdts, Marilena Giannetti, Matthew Greenhawt, Maria Antonieta Guzmán, Elham Hossny, Paula Kauppi, Carla Jones, Francesco Lucidi, Olga Patricia Monge Ortega, Daniel Munblit, Antonella Muraro, Giovanni Pajno, Marcia Podestà, Pablo Rodriguez del Rio, Maria Said, Alexandra Santos, Marcus Shaker, Hania Szajewska, Carina Venter, Cristopher Warren, Tonya Winders, Motohiro Ebisawa, Alessandro Fiocchi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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 Methods: Phase 1: We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts.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.

Original languageEnglish (US)
Article number100753
JournalWorld Allergy Organization Journal
Issue number3
StatePublished - Mar 2023


  • Consensus
  • Definition
  • Food allergy
  • Severity
  • e-Delphi study

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Immunology


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