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 Bozzola; Robert 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

doi:10.1016/j.waojou.2023.100753

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 journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Article number	100753
Journal	World Allergy Organization Journal
Volume	16
Issue number	3
DOIs	https://doi.org/10.1016/j.waojou.2023.100753
State	Published - Mar 2023

Keywords

Consensus
Definition
Food allergy
Severity
e-Delphi study

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Immunology and Allergy
Immunology

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10.1016/j.waojou.2023.100753

Cite this

Arasi, S., Nurmatov, U., Dunn-Galvin, A., Roberts, G., Turner, P. J., Shinder, S. B., Gupta, R., Eigenmann, P., Nowak-Wegrzyn, A., Ansotegui, I. J., Rivas, M. F., Petrou, S., Tanno, L. K., Vazquez-Ortiz, M., Vickery, B., Wong, G., Alvaro-Lozano, M., Asaria, M., Begin, P., ... Fiocchi, A. (2023). WAO consensus on DEfinition of Food Allergy SEverity (DEFASE). World Allergy Organization Journal, 16(3), [100753]. https://doi.org/10.1016/j.waojou.2023.100753

@article{86016634e2ef4c479e2d1d1697d1e1c7,

title = "WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)",

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.",

keywords = "Consensus, Definition, Food allergy, Severity, e-Delphi study",

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

note = "Funding Information: This is a project of the World Allergy Organization (WAO), supported by a grant from Novartis , as well as Abbott Laboratories and Food Allergy Research & Education ( FARE ). The funder had no role in the development of the protocol, the conduct of e-Delphi study and its publication. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = mar,

doi = "10.1016/j.waojou.2023.100753",

language = "English (US)",

volume = "16",

journal = "World Allergy Organization Journal",

issn = "1939-4551",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

Arasi, S, Nurmatov, U, Dunn-Galvin, A, Roberts, G, Turner, PJ, Shinder, SB, Gupta, R, Eigenmann, P, Nowak-Wegrzyn, A, Ansotegui, IJ, Rivas, MF, Petrou, S, Tanno, LK, Vazquez-Ortiz, M, Vickery, B, Wong, G, Alvaro-Lozano, M, Asaria, M, Begin, P, Bozzola, M, Boyle, R, Brough, H, Cardona, V, Chinthrajah, RS, Cianferoni, A, Deschildre, A, Fleischer, D, Gazzani, F, Gerdts, J, Giannetti, M, Greenhawt, M, Guzmán, MA, Hossny, E, Kauppi, P, Jones, C, Lucidi, F, Monge Ortega, OP, Munblit, D, Muraro, A, Pajno, G, Podestà, M, Rodriguez del Rio, P, Said, M, Santos, A, Shaker, M, Szajewska, H, Venter, C, Warren, C, Winders, T, Ebisawa, M & Fiocchi, A 2023, 'WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)', World Allergy Organization Journal, vol. 16, no. 3, 100753. https://doi.org/10.1016/j.waojou.2023.100753

TY - JOUR

T1 - WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)

AU - Arasi, Stefania

AU - Nurmatov, Ulugbek

AU - Dunn-Galvin, Audrey

AU - Roberts, Graham

AU - Turner, Paul J.

AU - Shinder, Sayantani B.

AU - Gupta, Ruchi

AU - Eigenmann, Philippe

AU - Nowak-Wegrzyn, Anna

AU - Ansotegui, Ignacio J.

AU - Rivas, Montserrat Fernandez

AU - Petrou, Stavros

AU - Tanno, Luciana K.

AU - Vazquez-Ortiz, Marta

AU - Vickery, Brian

AU - Wong, Gary

AU - Alvaro-Lozano, Montserrat

AU - Asaria, Miqdad

AU - Begin, Philippe

AU - Bozzola, Martin

AU - Boyle, Robert

AU - Brough, Helen

AU - Cardona, Victoria

AU - Chinthrajah, R. Sharon

AU - Cianferoni, Antonella

AU - Deschildre, Antoine

AU - Fleischer, David

AU - Gazzani, Flavio

AU - Gerdts, Jennifer

AU - Giannetti, Marilena

AU - Greenhawt, Matthew

AU - Guzmán, Maria Antonieta

AU - Hossny, Elham

AU - Kauppi, Paula

AU - Jones, Carla

AU - Lucidi, Francesco

AU - Monge Ortega, Olga Patricia

AU - Munblit, Daniel

AU - Muraro, Antonella

AU - Pajno, Giovanni

AU - Podestà, Marcia

AU - Rodriguez del Rio, Pablo

AU - Said, Maria

AU - Santos, Alexandra

AU - Shaker, Marcus

AU - Szajewska, Hania

AU - Venter, Carina

AU - Warren, Cristopher

AU - Winders, Tonya

AU - Ebisawa, Motohiro

AU - Fiocchi, Alessandro

N1 - Funding Information: This is a project of the World Allergy Organization (WAO), supported by a grant from Novartis , as well as Abbott Laboratories and Food Allergy Research & Education ( FARE ). The funder had no role in the development of the protocol, the conduct of e-Delphi study and its publication. Publisher Copyright: © 2023 The Authors

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

KW - Consensus

KW - Definition

KW - Food allergy

KW - Severity

KW - e-Delphi study

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DO - 10.1016/j.waojou.2023.100753

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SN - 1939-4551

VL - 16

JO - World Allergy Organization Journal

JF - World Allergy Organization Journal

IS - 3

M1 - 100753

ER -

WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)

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